DISTRICT HEALTH PLAN 2015/2016
ZULULAND HEALTH DISTRICT
KWAZULU-NATAL
ZULULAND DISTRICT HEALTH PLAN 2015/16
1. ACKNOWLEDGEMENTS
The District Manager acknowledges the team members from all the institutions who contributed to the development of the District Health Plan.
I would like to acknowledge in particular, the District Health Service Delivery, Planning, Monitoring and evaluation component for coordinating the whole planning process to the finish.
The District Core Team is also acknowledged for their commitment and dedication in analysing, interpreting data and consolidating narratives from different sections. District Office team, Clinical Programme Coordinators, District Finance, District Engineer, District EMS Manager, District Human Resource Manager, and Quality & Infection Control coordinator made an informed contribution to the planning process. All Hospital & CHC Managements and their information teams played a significant role in inputting to the District Health Plan.
Special thanks go to our partners i.e. SHIPP for their support in making the DHP effective through their continuous support, HST,URC, Humana People to People for their support.
A special thanks to Provincial DOH Planning, Monitoring and Evaluation Component team, who have always been supportive and patient in ensuring that quality work, is achieved, through their guidance and inputs in the District strategic planning process.
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2. OFFICIAL SIGN OFF
It is hereby certified that this District Health Plan:
Was developed by the district management team of ZULULAND HEALTH DISTRICT with the technical support from the provincial district development directorate and the strategic planning unit. Was prepared in line with the current Strategic Plan and Annual Performance Plan of the Department of Health of KZN
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3. TABLE OF CONTENTS 1. ACKNOWLEDGEMENTS ...... 2 2. OFFICIAL SIGN OFF ...... 3 5. EXECUTIVE SUMMARY BY DISTRICT MANAGER ...... 8 PART A – STRATEGIC OVERVIEW ...... 13 6. SITUATIONAL ANALYSIS ...... 13 7. DISTRICT SERVICE DELIVERY ENVIRONMENT ...... 25 8. DISTRICT PROGRESS TOWARDS THE ACHIEVEMENT OF THE MDG’S ..... 33 9. PROVINCIAL AND DISTRICT CONTRIBUTION TOWARDS THE HEALTH SECTOR NEGOTIATED SERVICE DELIVERY AGREEMENT (NSDA) ...... 35 10. SUMMARY OF MAJOR HEALTH SERVICE CHALLENGES AND PROGRESS MADE FOR THE PREVIOUS THREE FINANCIAL YEARS ...... 37 11. ORGANISATIONAL ENVIRONMENT ...... 42 12. DISTRICT HEALTH EXPENDITURE ...... 47 PART B - COMPONENT PLANS ...... 50 13. SERVICE DELIVERY PLANS for district health services ...... 50 14. HIV & AIDS & TB CONTROL (HAST) ...... 68 15. MATERNAL, NEONATAL, CHILD AND WOMEN’S HEALTH AND NUTRITION ...... 78 16. DISEASE PREVENTION AND CONTROL (Environmental Health Indicators) .... 93 17. INFRASTRUCTURE, EQUIPMENT AND OTHER SUPPORT SERVICES ...... 99 18. SUPPORT SERVICES ...... 101 19. HUMAN RESOURCES ...... 107 20. DISTRICT FINANCE PLAN ...... 116 PART C: LINKS TO OTHER PLANS ...... 118 21. CONDITIONAL GRANTS (Where applicable) ...... 118 22. PUBLIC-PRIVATE PARTNERSHIPS (PPPs) and PUBLIC PRIVATE MIX (PPM) ...... 120 PART E: INDICATOR DEFINITIONS ...... 120
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4. LIST OF ACRONYMS
Abbreviations Description
A
AIDS Acquired Immune Deficiency Syndrome
ANC Ante Natal Care
APP Annual Performance Plan
ART Anti-Retroviral Therapy
ARV Anti-Retroviral
B
BAS Basic Accounting System
BLS Basic Life Support
BUR Bed Utilisation Rate
C
CARMMA Campaign on Accelerated Reduction of Maternal and Child Mortality in Africa
CCG’s Community Care Givers
CEO(s) Chief Executive Officer(s)
CHC(s) Community Health Centre(s)
COE Compensation of Employees
D
DCST(s) District Clinical Specialist Team(s)
DHER(s) District Health Expenditure Review(s)
DHIS District Health Information System
DHP(s) District Health Plan(s)
DHS District Health System
DOH Department of Health
DQPR District Quarterly Progress Report
E
EMS Emergency Medical Services
ETB.R Electronic Tuberculosis Register
ETR.net Electronic Register for TB
F
G
G&S Goods and Services
H
HAST HIV, AIDS, STI and TB
HCT HIV Counselling and Testing
HIV Human Immuno Virus
HOD Head of Department
HPS Health Promoting Schools
HPV Human papillo virus
HR Human Resources
HTA High Transmission Area
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Abbreviations Description
I
IDP(s) Integrated Development Plan(s)
IPT Ionized Preventive Therapy
J
K
KZN KwaZulu-Natal
L
LG Local Government
M
M&E Monitoring and Evaluation
MDG Millennium Development Goals
MDR-TB Multi Drug Resistant Tuberculosis
MEC Member of the Executive Council
MNC&WH Maternal, Neonatal, Child & Women’s Health
MO Medical Officers
MOU Maternity Obstetric Unit
MTEF Medium Term Expenditure Framework
MTSF Medium Term Strategic Framework
MUAC Mid-Upper Arm Circumference
N
NDOH National Department of Health
NCS National Core Standards
NGO(s) Non-Governmental Organisation(s)
NHI National Health Insurance
NIMART Nurse Initiated and Managed Antiretroviral Therapy
O
OSD Occupation Specific Dispensation
OSS Operation Sukuma Sakhe
P
P1 Calls Priority 1 calls
PCR Polymerase Chain Reaction
PCV Pneumococcal Vaccine
PDE Patient Day Equivalent
Persal Personnel and Salaries System
PHC Primary Health Care
PN Professional Nurse
R
RV Rota Virus Vaccine
S
SCM Supply Chain Management
SHS School Health Services
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Abbreviations Description
SLA Service Level Agreement
Stats SA Statistics South Africa
STI(s) Sexually Transmitted Infection(s)
T
TB Tuberculosis
U
V
VCT Voluntary Counselling and Testing
W
X
XDR-TB Extreme Drug Resistant Tuberculosis
Y and Z
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5. EXECUTIVE SUMMARY BY DISTRICT MANAGER
Introduction
2015/2016 is a special financial year in the government business. It is the first full Financial Year of the current administration. It comes at a time when new decisions have been taken to move South Africa forward. It is built on the past years achievements and challenges. The marching orders this time around are that “we must speak less and do more”
Service Delivery
There has been a change in the demographic characteristics of Zululand Health District, following Census 2011 population figures from Statistics South Africa. The total catchment population of the district decreased from 862 110 to 824 091. A huge population shift is noted amongst sub-districts. Ulundi sub- district had the highest population and Abaqulusi and Nongoma had equal population figures. Currently Abaqulusi has the highest population of 217 774 followed by Nongoma municipality with 198 462 then Ulundi municipality with 192 475.
The information on social determinants of Health from the community survey of 2007 suggests that Nongoma Municipality had the highest poverty rate, where 81% of the population lives below the poverty line of R283 per month. Access to portable water in the district is 79.8%, the literacy rate is 60.9% and only 21% of households have access to electricity.
The top 5 causes of mortality for adults are PTB, HIV, Lower Respiratory Tract Infections, diarrhoea and cerebro -vascular accidents. These causes of death still need to be refined by ensuring that the final diagnosis and causes of death are in line with DOH classification.
The PHC utilization rate in the district has increased by 0.2%. Stagnation in the PHC utilization rate at 2.7 visits per year is noted at Abaqulusi, Dumbe and Pongola. PHC facilities of Nongoma municipality are not adequately accessible to the public, which results in the over utilization of the hospital for PHC services. Human Resources and Infrastructural challenges have impact on the accessibility of these facilities.
Zululand Health District has five district hospitals, 2 specialized hospitals, 68 clinics, 1 CHC and 17 Mobile clinic teams. There is one new clinic under construction in Ulundi, Mashona, which is 90% completed. Ulundi municipality has the largest number of clinics compared to Abaqulusi municipality, which is the largest population in terms of Census 2011.
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Health facilities under Ulundi municipality produces less headcount compared to the resources allocated. There are arears such as Babanango which is still under served with clinics.
The district topography, communication and transport infrastructure contribute to lack of access to services for pockets of the community, hence the need for mobile services.
MDGs targets
Challenge: 94% of the district population is uninsured, about 70% of the population is living below the poverty line of R 283 per month (community survey 2007). The district is therefore struggling to achieve targets in terms of reduction of malnutrition. The district performance is 4.4 children are underweight for age which is higher than the target of 2.3.
The under-five child mortality is high, at 7.3/1000 against the target of 5.3/1000. Immunization coverage is 80% instead of 90%, while the MMR seems to be gradually dropping, as it was 124.2/100 000 in 2013/14 against the target of 144/100 000, there are still too many preventable deaths.
Contraceptive prevalence is very low at 37% instead of at least 40%. TB cure rate has improved dramatically to reach the target of 85%, but there is still a need to improve case finding, reduce deaths of patients on TB treatment and prevent MDR.
District plan is to intensify prevention of diseases at community level by implementing PHC re-engineering, improve the quality of health care given at clinic level and strengthen PHC support by all health care providers.
District is lucky to have 4/7 DCST members who are providing an excellent contribution to service delivery in support of frontline staff. Even though there is staff turnover, the district is able to keep a stable force that provides management and administrative support.
The district has 6 Family Health Teams; they cover six wards out of a total of 89 wards. Management in the district have displayed commitment to deploy staff from facilities to work in the community, the main challenge is lack of transport.
There is a need to increase mobile teams at Abaqulusi and Nongoma municipalities, as well as build at least one new clinic in Nongoma.
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The District is experiencing a challenge in the implementation of PHC re-engineering due to lack of transport. Only 8 out of 14 School Health Teams. TB injection teams and FHTs also do suffer from shortage of transport.
The district has come up with an idea to request Head Office to support with implementation of subsidized vehicles in order to improve PHC support.
District hospitals are working hard to improve their status on compliance with National Core Standards (NCS). PHC facilities are lagging behind in terms of NCS compliance. Management in the district has made a commitment to work towards improving the situation.
Implementation of complaints management at clinics is a challenge. District hospitals have a well-established system. Clinics have to be supported to improve their performance in this area.
Support services
Monitoring and support of pharmaceutical services suffered a knock due to the district pharmacy manager being on long sick leave before he retired on 30/09/2014. The district has recently appointed a new deputy manager to coordinate and support institutional pharmacists.
Infrastructure
District PHC facilities are not equitably distributed. The road infrastructure and topography influences access to health facilities in the district. Nongoma municipality is the second largest sub district with 13 clinics and 3 mobile teams while Ulundi has 24 clinics and 6 mobile teams. Abaqulusi has 15 clinics and 3 mobile teams. The district plans to increase the number of mobile teams at Abaqulusi- sub district and both residential clinics and mobile teams under Nongoma municipality to improve equity in distribution of health facilities. IDP planning between the Department of Health and Municipality should address social determinants of Health, mainly road infrastructure to improve access to health services by the people of Nongoma. The district will prioritize upscaling PHC reengineering teams to bring services to the people and to bridge gaps in areas under served with clinics.
PHC facilities do not have access to networks such as emails and internet and sometimes cell phone network. The DOH is working on the project to get clinics connected.
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Finance
The District spends 45% of its budget on district hospital and 26% on Primary Health Care. A shift in the budget is anticipated to support the PHC re- engineering contrary to the current hospicentric services. Inefficiencies are noted when comparing resources allocation and outputs at Ulundi municipality. A clear picture would be painted if Ceza service area could be viewed separately from the Ulundi municipality. A recommendation was made to separate Ceza and Nkonjeni areas into two sub-districts.
The cost per head count is high at R211 in Edumbe and at Ulundi R 126. The situation at eDumbe could be attributed in part to the CHC package of care and the necessary resources at that level. The high cost for Ulundi can be as a result of low head count generated compared to the number of clinics and clinical staff allocated. Rationalization of HR is planned for 2015/16. The sub district has developed a clear plan to increase supervision and support PHC. The expenditure on goods and services seem to be shrinking compared to the cost of compensation of employees affecting the capacity of institution to purchase consumables necessary for service delivery. This is a districtwide occurrence which requires attention.
The cost per PDE at Ceza hospital and Benedictine hospital is high compared with other district hospital. Shortage of medical officers results in low output which does not match the input due to overhead costs. The district hospitals are looking at ensuring that the number of sessional doctors is reduced proportionally to the increase in the recruitment of permanent doctors. The other factor that has influence on the cost per PDE is the long average length of stay, above the norm of five days. This situation is attributable to the prevalence of chronic illness fuelled by TB and HIV. Human Resources
Total number of staff in the district is 4 854. District struggles to attract highly skilled professionals. However, the contract signed between the DOH and bursary holders is making a significant contribution in reducing vacancy rates.
The District seems to have an inequitable distribution of PNs among sub districts. This is most noticeable at Ulundi and Dumbe municipalities. The service deprivation in professional nurses is noticeable under Nongoma municipality, compromising quality of care at primary health care level, leading to a low PHC utilization rate and an over utilization of hospital services. Audit of professional nurses at PHC will be conducted in the entire district to address inequities. The improvement in Human resource and the rationalization of human capital would translate to improved utilization rates and service delivery in general.
The nurse clinical workload at both UPhongolo and Nongoma, municipalities is at 36 patients per professional nurse, while the PHC utilization rate for Pongola is 2.7 and Nongoma is 2.2 visits per year. PHC services at Nongoma appear to be less accessible to the population they serve. The team from Nongoma sub-district is developing a plan to improve the staff compliments of the professional nurses at PHC level and increase access to health facilities in the financial year 2015/16. The whole district has
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resolved to conduct the human resource audit to identify challenges in clinical workload impacting on service delivery and consider re-allocation of existing staff to where they are most needed.
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PART A – STRATEGIC OVERVIEW
6. SITUATIONAL ANALYSIS
Zululand district is located in the northern part of KwaZulu Natal and it covers an area of approximately 14 810 km. It is nestled between four districts; uMkhanyakude in the east, uThungulu in the South, UMzinyathi South West & Amajuba in the North West, Mpumalanga province and Swaziland in the north. The district is deep rural, one of the presidential rural nodes with a high unemployment and poverty rate. It is mountainous with poo r road infrastructure; poor transport making accessibility a challenge for the district as a result there is more access in urban facilities compared to rural facilities. Zululand is divided into five sub districts, namely: Abaqulusi, eDumbe, Nongoma, Pongola and Ulundi. The district has 5 district hospitals, 3 state aided hospitals, 2 specialist hospitals 1 CHC and 68 clinics. There is currently 1 clinic under construction (Mashona clinic) in Ulundi sub district which is 98% complete.
Abaqulusi local municipality has the largest population in the whole district. Abaqulusi Municipality comprises of both rural and urban areas, and it also comprises of areas that are densely populated e.g. Mondlo and has Vryheid being its main urban town. It has 1 district hospital, 2 state aided hospitals, 15 clinics, 3 mobiles, 50 mobile points and only 44 points are being serviced. Edumbe local municipality has the least population and is predominantly rural in nature comprising of 1 CHC, 6 clinics, 2 mobiles, 62 mobile points and 56 points are being serviced. Nongoma local municipality has the second largest population in the district. It is grossly rural with scattered communities in mountainous areas in tribal authorities. It is has very poor gravel road infrastructure which are not accessible during rainy season, poor road infrastructure contributing to early wear and tear of mobile vehicles. It has 1 district hospital, 14 clinics, 3 mobiles & 90 mobile points and only 68 are being serviced. 25 grey areas that are not reachable through mobiles, where clients have to walk long distances to access services.
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Ulundi local municipality has the third largest population after Nongoma. It is rural and underdeveloped with Ulundi as the only urban center which is highly populated and has densely populated peri urban areas surrounding Ulundi and along the main routes (R66 & R34). This sub district has 2 district hospitals, 24 clinics, 6 mobiles, 122 mobile points and only 117 are serviced. UPhongolo local municipality is in the northern part of Zululand and has the fourth largest population in the district. Pongola is the main urban area. It has the route N2 connecting Durban Richards bay Swaziland and Gauteng passing through. There is 1 district hospital, 1 private state subsidized hospital, 10 clinics, 3 mobiles, 88 mobile stopping points of which only 75 are being serviced. This sub district provides service to clients from neighboring Swaziland which has cost implications.
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6.1 MAJOR DEMOGRAPHIC CHARACTERISTICS
Figure 1: Population Pyramid Zululand District 2013 Stats SA
The Total population for the district has decreased from 862 110 to 824 091 when compared to the 2012/13 population figures. Gender proportions indicate that there is a higher proportion of females compared to males, and females have increased from 50.9% to 53.2% and
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males have decreased from 49.1% to 46.7%, most probably due to HIV/AIDS, TB related infections or due to migration to seek employment in the cities. This pyramid also shows that the age groups 15-19 have the highest population in the district followed by 10-14, showing that the district has a relatively young population. This means the district has to focus on strategies that will focus on strengthening services such as sexual and reproductive health, youth friendly services, school health and interventions to reduce new HIV infections and strengthen child health services, IMCI, initiation of ART to children under 5.
Table 1: District Population 2013/14
Sub-District Total Population % pop uninsured Uninsured Population
kz Ulundi Local Municipality 192 475 93.50 179 964.1 kz uPhongolo Local Municipality 131 312 93.50 122 776.7 kz eDumbe Local Municipality 84 068 93.50 78 603.6 kz Abaqulusi Local Municipality 217 774 93.50 203 618.7 kz Nongoma Local Municipality 198 462 93.50 185 562 DISTRICT TOTAL 824 091 93.50 770 525.1 Source: DHER 2012/13
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Graph 1: Population distribution per Municipality
Abaqulusi
131 312 217 774 Edumbe
192 475 84 068 Nongoma
198 462 Ulundi
uPhongolo
Source: DHIS
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There has been a huge population shift. In 2013/14 Ulundi sub district had the highest population and Abaqulusi & Nongoma were equal. Currently Abaqulusi sub district has the largest population followed by Nongoma
6.2 SOCIAL DETERMINANTS OF HEALTH Table 2 (A1): Social Determinants of Health
Sub-Districts Data Source Total Unemployment Percentage Number of Number of Percentage Households Percentage Adult number of rate of households households of with of literacy households population in Informal in formal Households access to Households rate living below dwelling dwelling with access potable with access poverty line to water to of R283 per sanitation electricity month
Census 2001 37 064 59.5% 1261 20 043 36.4% 63.5% 43.2% 69.8%
Abaqulusi Community Survey 2007 39 866 40% 68% 2 153 26 070 79% 2% 41%
Census 2011 43 299 35.3% 1 743 33 417 40.9% 38.8% 72.1% 83.1%
Census 2001 15 824 57.5% 310 8 696 5.2% 62.9% 31.3% 62.3%
Edumbe Community Survey 2007 15 147 39% 72% 339 7 596 95% 15% 26%
Census 2011 16 138 37.7% 570 11 529 5.5% 13.8% 62.8% 81.7%
Nongoma Census 2001 32 473 71.7% 374 11 250 6.0% 30.5% 24.6% 54.7%
Community Survey 2007 35 293 63% 81% 507 7 995 54% 7% 30%
Census 2011 34 341 49.3% 2127 20 307 4.5% 9.6% 63.6% 79.5%
Census 2001 34 856 66.7% 1383 13 916 20.2% 45.8% 40.2% 55%
Ulundi Community Survey 2007 38 513 54% 68% 188 14 341 71% 2% 54%
Census 2011 35 196 49.4% 1038 22 263 19.1% 22.2% 73.4% 79.4%
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uPhongolo Census 2001 26 954 48.7% 398 15 605 9.1% 60.6% 53.5% 62.9%
Community Survey 2007 25 740 51% 72% 1 614 18 481 83% 1% 50%
Census 2011 28 772 35.5% 651 23 790 11.4% 17.4% 73.0% 80.1%
District Total Census 2001 147 172 39% 8 885 69 510 79.8% 52.2% 21% 60.9%
Community Survey 2007 154 559 50% 4 801 74 483 88.8% 54.5% 33.9%
Census 2011 157 749 41% 6 126 111 306 86.7% 69.3% 38.2% 80.8%
The unemployment rate is at 41% for the whole district according to census 2011, and a marked improvement is noted in Pongola & Nongoma sub district, however the district is generally underdeveloped and has a lack of economical investments to boost the local economy. Nongoma sub district has the highest percentage (81%) of population living below poverty line or R283per month, followed by eDumbe & Phongolo sub districts. The percentage of Adult literacy rate has improved overall for the district 80.8% according to census 2011and has improved very well in the sub districts as well. Number of households with access to portable water & electricity has also increased. Informal dwellings have increased which will contribute to increase in communicable diseases. The district will identify these so through OSS the different problems can be addressed. There is also a decrease to households with access sanitation possibly due to the increase to informal dwellings which will also be addressed through OSS.
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6.3 EPIDEMIOLOGICAL (DISEASE) PROFILE OF THE DISTRICT
10 Major causes of death Adults 2011/12 Adults 2012/13 Adults 2013/14 1. PTB 701 HIV 431 PTB 407 2. HIV 439 PTB 424 HIV 184 3. Diarrhoeal Disease 292 Diarrhoeal Disease 189 LRTI 147 4. Meningitis 198 LRTI 161 Diarrhoeal Disease 137 5. LRTI 130 PTB+RVD 136 Cerebrovascular Disease 112 6. Diabetes mellitus 117 Meningitis 133 Pneumonia 64 7. Pneumonia 95 Diabetes mellitus 104 Meningitis 58 8. Cerebrovascular Disease 82 Pneumonia 95 Diabetes Mellitus 51 9. Hypertension 78 Cardiac Disease 77 Hypertension 39 10. Cardiac Disease 77 Hypertension 69 Cardiac Disease 26 Source: Hospital Mortality Data
Maternal Mortality & Child Mortality Indicators 2011/12 2012/13 2013/14
Maternal Mortality rate 154.4 108.5 123.3/100 000(20/16 223)
Neonatal mortality rate 13.6/1000 6.7/1000 5.6/1000 (10/16 223)
Facility child mortality rate 8/1000 12.1/1000 12.3/1000 ( 267/16 223)
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District HIV & Aids Profile
HIV Prevalence Zululand 2010- 2012 41 40 39 39.8 39.3 38 37 36 HIV PREVALENCE % 35 35 34 33 32 2010 2011 2012
Source: District Health Barometer 2013/14
District TB Profile 2011/12 2012/13 2013/14
TB Cure Rate 76% 84.4%(1434/1694) 84.3%(1260/15000
TB Death Rate 10% 4.8%(99/1694) 5.8%(103/1500)
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Figure 2: Disease Profile
TOP 10 Causes of Deaths in Adults 2013/14
1.PTB 407
2.HIV/AIDS 184
3.Lower Respiratory Tract Infections 147
4.Diarrhoeal Diseases 137
5.Cerebrovascular Disease 112
6.Pneumonia 64
7.Meningitis 58
8.Diabetes Mellitus 51
9.Hypertension 39
10.Cardiac Disease 26
0 50 100 150 200 250 300 350 400 450
Source: Hospital Mortality Data
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Ten Leading Causes of Years of Life Lost
1.TB 26.3
2.HIV 14.5
3.LRI 9.9
4.Diarrhoeal Disease 8.6
5.Cerebrovascular Disease 4.1
6.Meningitis/Encephalitis 3.2
7.Road Injuries 3
8.Diabetes Mellitus 1.9
9.Ischeamic Heart Disease 1.6
10.Preterm Birth Complications 1.6
0 5 10 15 20 25 30
Source: District Health Barometer 2013/14
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7. DISTRICT SERVICE DELIVERY ENVIRONMENT
7.1 DISTRICT HEALTH FACILITIES
7.1.1 PRIMARY HEALTH CARE FACILITIES
Table 3 (NDoH 1): PHC facilities (Provincial and LG combined) per Sub-District as at 31 March 2014
Sub-Districts Health Posts Mobiles Satellites Clinics Community Day Community Standalone District Centre1 Health Centres MOU3 Hospitals (24 x 7)2
LG P LG P LG P LG P LG P LG P LG P Abaqulusi 3 15 1 Edumbe 2 6 1 Nongoma 3 13 1 Ulundi 6 24 2 uPhongolo 3 10 1 District 17 68 1 5
Source: DHIS The Health facilities are distributed inequitably. Ulundi sub district is adequately resourced with 24 clinics and 6 mobiles, another clinic Mashona to be opened soon, although some areas (Babanango) is still being serviced by a mobile and is in dire need of a clinic. Nongoma sub district opened 2 clinics, but there are areas that still need clinics, bearing in mind the topography of their area which is grossly rural with mountainous areas very poor road infrastructure and grey areas that are not accessible even through mobiles. Nongoma has to increase their mobile teams so as to improve their access which will improve their utilization rate which is currently 2.2.
1 There are no Commlunity Day Centres in KwaZulu-Natal 2 All Community Health Centres (CHC’s) in KwaZulu-Natal do not have MOU’s according to the definitions used in the DHER 2011/12. All KZN CHC’s operate on a 24 hour, 7 day a week basis. 3 Accordingly to the DHER 2011/12 definitions for Stand Alone MOU’s, there are no Stand Alone MOU’s operational within KwaZulu-Natal
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There is a need for additional mobile team for UPhongolo, and Abaqulusi municipalities whilst waiting for the building of new clinics. At present there is a shortage of mobile vehicles and the ones that are being used are old, not user –friendly for the service. Needs analysis has been done and submitted to Head Office. There is only one CHC in the district – STP has not been implemented yet especially with regard to proposed CHCs and MOUs.
Table 4: Provincial Clinic Facility to Population – 2013/14
Sub-Districts/ District PHC facility per pop ratio - Health PHC facilities per pop - Mob PHC facilities per pop ratio - Clinical PHC facilities per pop ratio - CHC Post provincial provincial provincial
Abaqulusi 72 591.30 14 518.30
Edumbe 42 034.00 14 011.30 84 068.00
Nongoma 66 154.00 15 266.30
Ulundi 32 079.20 8 019.80
uPhongolo 43 770.70 13 131.20 Source: DHER 2013/14 Customised District Report The number of facilities in relation to the population is at 78% a 6% improvement from 72% in 2012/13. Nongoma opened two clinics but still showing that it is under serviced; this sub district has 14 clinics, 3 mobiles and 68 stopping points. There is a need to increase their mobile teams which will help to improve access.
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Table 5 (NDoH 2): District Hospital Catchment Populations 2013/14
Name of District Hospital 2012/13 2013/14 Ceza Ceza Ceza Vryheid Vryheid Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Hospital Nkonjeni Nkonjeni Itshelejuba Itshelejuba Benedictine Benedictine Itshelejuba Itshelejuba Hospital
Catchment Population of District Hospital 56 004 33 836 65 836 65 552 64 092 65323 39466 76460 76791 74757 Source: DHER 2013/14 (GIS)
Note: District Hospital Catchment Populations are calculated according to the catchment population of referring clinics.
The district does not have Regional and Tertiary institutions. There are 5 district hospitals, 2 specialized hospitals and 3 state aided hospitals. The catchment population has increased for all the district hospitals when compared to 2012/13, which places a huge burden on district hospital services that were already functioning under strain due to shortage of medical doctors’ especially Benedictine, Ceza & Nkonjeni hospitals. Clients needing care not rendered at the district hospital level are referred to the next level of care.
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7.1 TRENDS IN KEY DISTRICT HEALTH SERVICE VOLUMES 7.1.1 PRIMARY HEALTH CARE SERVICE VOLUMES AND UTILISATION
Table 6 (NDoH 3): PHC Headcount Trend
Sub-District 2012/13 2013/14 Variation
PHC PHC Total PHC Total PHC PHC Total PHC Total PHC PHC Total PHC Total Headcount – Headcount Utilisation Rate Headcount – Headcount Utilisation Rate Headcount – Headcount Utilisation Rate Provincial Provincial Provincial Abaqulusi 557 171 557 171 2.7 569 785 569 785 2.7 12 614 12 614 0 Edumbe 244 037 244 037 2.7 231 106 231 106 2.7 -12 931 -12 931 0 Nongoma 395 304 395 304 1.9 444 730 444 730 2.2 49 426 49 426 0.3 Ulundi 481 370 481 370 2.1 529 450 529 450 2.8 48 080 48 080 0.7 uPhongolo 355 858 355 858 2.7 351 567 351 567 2.7 - 4 291 - 4 291 0
District 2 033 740 2 033 740 2.4 2 126 638 2 126 638 2.6 92 898 92 898 0.2
Source: DHIS downloads There has been a remarkable increase in PHC headcount in the district of 92 898 due to a noted increase in Nongoma, Ulundi and Abaqulusi sub districts. Nongoma sub district opened 2 clinics and 6 new mobile points thus increasing accessibility especially in hard to reach areas. Ulundi sub district also opened 2 clinics. Although there was an increase in the headcount for Abaqulusi but the utilisation rate remains the same for the past 2 years at 2.7. a decrease in headcount is seen at eDumbe and Pongola sub districts but their utilisation rates have remained the same at 2.7 for both years. The decrease in headcount needs to be investigated.
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Graph 2: PHC Utilisation (Provincial Clinics) vs. Population to PHC facility (Provincial clinics) – 2013/14
2.8 350000 2.7 2.7 2.7 3 2.6 300000 2.2 2.5 250000 2 200000 1.5 150000 321582 1 100000 0.5 50000 87109 81420 56054 40099 56901 0 0 Abaqulusi Edumbe Nongoma Ulundi uPhongolo District
Population to PHC facility (avg) PHC utilisation Rate
Source: DHIS & DHER 2013/14 Customised District Report
Abaqulusi and Nongoma sub districts have a higher population to PHC facilities when compared to other sub districts. Ulundi sub district is adequately resourced in terms of health care facilities, seen also in their utilisation rate which has increased from 2.1 to 2.8, but they are the sub district that has reached the lowest population in spite of the resources they have.
Graph 3: PHC Utilisation rate in relation to PN Workload Provincial Clinics
3 36 36 40 32 32 32 35 2.5 30 2 24 25
1.5 20 2.8 2.7 2.7 2.7 2.6 2.2 15 1 10 Workload Rate PHC Utilisation Rate PHC Utilisation 0.5 5
0 0 Abaqulusi Edumbe Nongoma Ulundi uPhongolo District
PHC Utilisation rate PN Workload
Source: DHIS, DHER
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Ulundi sub district has the highest utilization rate 2.8, but still below the target of 3 and lowest PN workload. This indicates that the LM is well resourced in PNs & clinics and can still perform much better to increase their utilization with the resources they have. Abaqulusi and Edumbe have slightly improved their PN workload, though it is still below the norm and their utilization rate remains the same. Both these LM are also adequately resourced with PN and clinics as indicated in graph 5 below. This indicates that the PNs in these areas are not utilized to their full capacity to cover the entire population, if this can turnaround there is possibility for the increase in utilization rate if the nurses can start to see more clients to a normal ratio of 1:40 through marketing of health services, increasing health facilities access, intersectoral collaborative efforts (Operation MBO) and through the implementation of recommendations from Client Satisfaction surveys. Edumbe sub district has a CHC. The utilization rate at Nongoma has increased from 1.9 to 2.2, is still below the norm but they have a high workload, which indicates that the existing facilities and the staff are not coping with the workload. Another challenge for low utilization is that the entire population is not covered by the existing facilities and the mobile services are also not adequate. UPhongolo shows the correlation between workload and the utilization rate. The district needs to consider the equity in allocation and distribution of resources
Table 7 (NDoH 4): District Hospital activities
District Hospitals Year Benedictine Ceza Itshelejuba Nkonjeni Vryheid District Hospital Hospital Hospital Hospital Hospital Totals
1. Inpatient 2012/13 86 208 29 503 40 883 66 770 81 018 304 382 Days – total 2013/14 89 080 30 083 45 467 68 077 83 818 316 525
Variation 2872 580 4584 1307 2800 12143
2. Day 2012/13 5 0 151 1 38 195 patient – 2013/14 70 5 549 15 123 762 total Variation 65 5 398 14 85 567
3. OPD 2012/13 20 539 7 172 31 332 8 849 2 174 70 066 Headcount 2013/14 37 357 4 232 29 504 26 976 2 078 100 147 not referred Variation 16818 -2940 -1828 18127 -96 30081 new
4. Inpatient 2012/13 12 887 4 075 6 956 8 817 17 375 50 111 Separations 2013/14 12 182 4 050 7 607 9 078 17 438 50 355
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District Hospitals Year Benedictine Ceza Itshelejuba Nkonjeni Vryheid District Hospital Hospital Hospital Hospital Hospital Totals
Variation -705 -25 651 261 63 244
5. Inpatient 2012/13 855 325 479 269 941 3229 Deaths 2013/14 775 281 439 613 988 3 096
Variation -80 44 -40 344 47 -133
6. OPD 2012/13 104 322 36 827 44 848 68 002 68 125 322 124 Headcount 2013/14 75 912 35 706 44 199 62 417 71 421 289 655 – total Variation -28 410 - 1 121 -649 -5585 3296 -32 469
7. Emergency 2012/13 17 750 877 2 627 3 649 4 708 29 611 headcount 2013/14 8 580 802 3 286 3 697 16 065 32 430 total Variation -9170 -75 659 48 11 357 2819
8. Patient Day 2012/13 24 538 83 850 112 691 180 092 213 407 833 579 Equivalent 2013/14 117 279 42 255 64 039 90 122 113 041 424 268
Variation 92 741 - 41 595 - 48 652 - 89 970 - 100 366 - 409 311
93 Cost per 2012/13 R1 631 R2 035 R1 511 R1 369 R1 424 R1 548 PDE 2013/14 R1 500 R1 820 R1 650 R1 700 R1 950 R1 724
Variation -R 131 -R215 -R 139 R 331 R 526 R 176
94 Delivery by 2012/13 23.9% 20.6% 20.4% 22.5% 30.3% 24.2% caesarean 2013/14 23.4% 23.7% 19.8% 26% 27.5% 22.9% section rate Variation -0.5% 3.1% -0.6% 3.5% -2.8% -1.3%
95 Average 2012/13 6.7 7.3 6.6 7.7 4.7 6.5 length of 2013/14 7.3 7.4 6.0 7.5 4.8 6.6 stay - total Variation 0.6 0.1 -0.6 -0.2 0.1 0.1
96 Inpatient 2012/13 61.3% 50.5% 73% 79% 66.0% 66.1% bed 2013/14 63.6% 51.5% 81.4% 81.1% 68.0% 69.12% utilisation rate – total Variation 2.3% 1% 8.4% 2.1% 2% 3.02%
97 Total 2012/13 122072 37704 47475 71651 72833 351735 Ambulatory 2013/14 84492 36508 77005 66114 87486 322085 (OPD Headcount Variation -37580 -1196 29530 -5537 14653 -29650 Total + Emergency Headcount total)
98 Ratio of 2012/13 1.0 1.3 1.1 1.1 1.1 5.6 Ambulatory 2013/14 0.9 1.2 1.6 1.0 1..0 1.0 to Inpatient Days Total
Variation 0.1 0.1 -0.5 0.1 0.1 4.6
Source: DHIS Downloads 2012/13 & 2013/14
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The OPD headcount not referred is very high at Benedictine and Nkonjeni hospitals as these hospitals are experiencing a shortage of Drs and they are both nearer town which makes them more accessible. Vryheid Hospital has a very high number of emergency headcounts which needs to be investigated when looking at the variance between the two financial years. Average length of stay is high at Benedictine, Ceza and Nkonjeni hospitals which are above 7. This can be attributed to the shortage of doctors in these hospitals; patients stay long because when they are admitted they are very sick as they delay in seeking medical help.
Graph 4: District Hospitals Cost per PDE vs. IPD and OPD
80% R 2 500 76% 76% 74% 71% 71% 70% R 2 000 60% R 1 950 R 1 820 50% R 1 650 R 1 700 R 1 500 R 1 500 40%
R 1 000 30% 28% 20% 23% 23% 22% 21% R 500 10%
0% R - Benedictine Ceza Itshelejuba Nkonjeni Vryheid
Total IPD as % of PDE Total OPD as % of PDE Cost per PDE
Source: DHER 2013/14 Customised District Report
Benedictine hospital has spent within the norm, lowest cost per PDE which is expected due to the highest OPD headcount. Ceza Hospital has the highest cost per PDE after Vryheid hospital because they are seeing the least clients in OPD. Vryheid hospital has the highest cost per PDE due to the fact that they are having the highest number of emergency headcount, which is almost twice that of Benedictine.
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8. DISTRICT PROGRESS TOWARDS THE ACHIEVEMENT OF THE MDG’S
Table 8 (NDoH 5): Review of Progress towards the Health-Related Millennium Development Goals (MDG’s) and required progress by 2015
MDG Target Indicator Provincial progress Source of District progress District targeted 2013/14 data 2013/14 progress 2014/15
Goal 1: Halve, between 1990 Prevalence of underweight DHIS 4.4 Eradicate Extreme and 2015, the children under 5 years of age Poverty And proportion of people Severe malnutrition under 5 years DHIS 3.7/1000 Hunger who suffer from hunger incidence ) 2.3/1000 6.5/1000
Goal 4: Reduce by two-thirds, Under-five mortality rate – use DHIS 7.3/1000 Reduce Child between 1990 and proxy “Inpatient death under 5 Mortality 2015, the under-five years rate” mortality rate Infant mortality rate – use proxy DHIS 12.3/1000 5.3/1000 “Child under 1 year mortality in 12/1000 facility rate”
Goal 4: Reduce by two-thirds, Measles 2nd Dose coverage DHIS 70.3% Reduce Child between 1990 and Immunisation coverage under 1 DHIS 80.6% Mortality 2015, the under-five mortality rate year 80% 90%
Goal 5: Reduce by three- Maternal mortality ratio (only DHIS 124.2/100 000 Improve Maternal quarters, between facility mortality ratio) Health 1990 and 2015, the maternal mortality rate Proportion of births attended by DHIS 72.8 skilled health personnel (Use 144/100 000 delivery in facility as proxy
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MDG Target Indicator Provincial progress Source of District progress District targeted 2013/14 data 2013/14 progress 2014/15
95% indicator)
Goal 6: Have halted by 2015, HIV prevalence among 15- 19- National HIV Combat HIV and and begin to reverse year-old pregnant women Syphilis AIDS, malaria and the spread of HIV and Prevalence other diseases AIDS Survey of SA HIV prevalence among 20- 24- National HIV year-old pregnant women Syphilis 40% Prevalence 85% Survey of SA
Contraceptive prevalence rate DHIS 37% (use Couple year protection rate as proxy)
TB Cure Rate ETR.Net 84.9%
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9. PROVINCIAL AND DISTRICT CONTRIBUTION TOWARDS THE HEALTH SECTOR NEGOTIATED SERVICE DELIVERY AGREEMENT (NSDA)
The National Development Plan 2030 was adopted by government as its vision for the health sector. It will be implemented over three electoral cycles of government. The MTSF 2014-2019 therefore finds its mandate from National Development Plan 2030.
Table 9: (NDoH): Alignment between NDP Goals 2030, Priority interventions proposed by NDP 2030 and Sub-outcomes of MTSF 2014-2019
NDP Goals 2030 NDP Priorities 2030 Sub-Outcomes 2014-2019 (MTSF)
Average male and female life expectancy at birth a. Address the social determinants that affect HIV & AIDS and Tuberculosis prevented and successfully increased to 70 years health and diseases Managed Tuberculosis (TB) prevention and cure progressively improved; d. Prevent and reduce the disease burden and promote health Maternal, infant and child mortality reduced
Prevalence of Non-Communicable Diseases reduced by Maternal, infant and child mortality reduced 28%
Injury, accidents and violence reduced by 50% from 2010 levels
Health systems reforms completed b. Strengthen the health system Improved health facility planning and infrastructure delivery
Health care costs reduced
c. Improve health information systems Efficient Health Management Information System for improved decision making
h. Improve quality by using evidence Improved quality of health care
Primary health care teams deployed to provide care to Re-engineering of Primary Health Care families and communities
Universal health coverage achieved e. Financing universal healthcare coverage Universal Health coverage achieved through implementation of National Health Insurance
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NDP Goals 2030 NDP Priorities 2030 Sub-Outcomes 2014-2019 (MTSF)
Posts filled with skilled, committed and competent f. Improve human resources in the health sector Improved human resources for health individuals Improved health management and leadership g. Review management positions and appointments and strengthen accountability mechanisms
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10. SUMMARY OF MAJOR HEALTH SERVICE CHALLENGES AND PROGRESS MADE FOR THE PREVIOUS THREE FINANCIAL YEARS
10.1. INTRA DISTRICT EQUITY IN THE PROVISION OF SERVICES
Table 10 (NDoH 6): PHC Expenditure
Sub-District PHC Expenditure / PHC Utilisation Rate Patient to PN % Share of District Uninsured Capita Provincial clinics Population
Abaqulusi R405.3 2.7 4160.7 27%
Edumbe R790.4 2.7 5247.0 10%
Nongoma R331.7 2.2 5389.7 24%
Ulundi R513.3 2.8 3754.0 23%
uPhongolo R371 2.7 4893.4 16% Source: DHER 2013/14 Customised District Report, DHIS
Ulundi sub district has the second highest PHC expenditure per uninsured after edumbe who has a CHC and it is expected, and the lowest patient to PN ratio and the highest utilisation rate. This shows that Ulundi has more professional nurses which are underutilised workload is 1:24. The patient to PN ratio for Nongoma is the highest in all the sub districts and expenditure is the lowest showing that Nongoma is not yet adequately resourced with PNs; though the utilisation rate has improved from 1.9 to 2.2 with more PNs they could improve.
Graph 5: Equity of resources vs population and headcount – 2013/14
30.0% 26.4% 26.8% 24.1% 23.4% 25.0% 20.9% 24.9% 20.0% 15.9% 16.5% 15.0% 10.2% 10.9% 26.8% 24.0% 10.0% 18.1% 17.9% 13.2% 5.0% 27.5% 14.3% 15.9% 28.2% 14.1% 0.0%
% Share of PN's % Share of Population % Share of Expenditure % share of PHC headcount
Source: DHER 2013/14 Customised District Report
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Abaqulusi sub district is adequately resourced and is able to reach their population, evidenced by the headcount which is equal to their percentage of the population. Edumbe is also able to reach their target population but at a high cost due to the CHC. Nongoma sub district is reaching most of their target population but they have a shortage of PNs and the second largest share of the population, they are overworked. Ulundi sub district is more than adequately resourced with PNs and is reaching their target population but because of high percentage share of PNs, it is costly, they have the highest expenditure. UPhongolo sub district has the lowest percentage share of PNs but is able to reach their target population seen in their headcount. Overall the PNs are not equitably distributed within the sub districts. There is a need for the district to consider redistribution of PNs especially to Nongoma and uPhongolo.
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Table 11 (NDoH 7 (a)): Number of patients to staff type (Sub-District) – PDoH PHC Clinics
Sub-District Specialist Administrator Administrator Clinical Staff Other Counsellor Data Capturer General / Worker Cleaner Medical Officer Nurse Assistant Pharmacist Assistant Basic Pharmacist Assistant Post Basic Pharmacist Professional Nurse Staff Nurse
Abaqulusi 38726.5 20137.8 251722.5 12908.8 125861.3 167815.0 4160.7 7628.0
30170.0 Edumbe 17240.0 40226.7 15085.0 30170.0 5247.0 4161.4
Nongoma 23579.9 10779.4 377278.0 29021.4 17965.6 5389.7 7397.6
20238.7 77581.8 17903.5 Ulundi 8312.3 155163.7 3754.0 5350.5
37924.1 uPhongolo 11669.0 33710.3 20226.2 15968.1 4893.4 6595.5
Source: DHER 2013/14 Customised District Report, DHIS
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Table 12 (NDoH 7 (b)): Number of patients to staff type (Sub-District) – CHC’s
Sub-District Specialist Counsellor Data Capturer General Worker / Cleaner Medical Officer Nurse Assistant Pharmacist Assistant Basic Pharmacist Assistant Post Basic Pharmacist Professional Nurse Staff Nurse Administrator Administrator Clinical Staff Other
Abaqulusi
Edumbe 3582.0 15521.8 9313.1 11641.4 31043.7 8466.5 31043.7 23282.8 2328.3 4049.2 Nongoma
Ulundi
uPhongolo
Source: DHER 2013/14 Customised District Report, DHIS
There has been an overall improvement with most staff categories when comparing with last year. The patient load on the medical officers remains high followed by pharmacists.
Note: There are no CDC’s operational in KwaZulu-Natal. Note: There are no Stand-Alone MOU’s in KwaZulu-Natal.
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Table 13 (NDoH 8): Population to Staff per sub-district – 2013/144
Sub-District Population to Medical Officers Population to Professional Nurses
Total Population Uninsured Population Total Population Uninsured Population
Abaqulusi 217 774 203 618.7 217 774 203 618.7
Edumbe 84 068 78 603 84 068 78 603 Nongoma 198 462 185 562 198 462 185 562
Ulundi 192 475 179 964.1 192 475 179 964.1
uPhongolo 131 312 122 776.7 131 312 122 776.7
Source: DHER 2013/14 Customised District Report, DHIS
4 District hospital plus PHC
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11. ORGANISATIONAL ENVIRONMENT
11.1 ORGANISATIONAL Structure of the District Management Team
District Manager (13)
SECRETARY
CORPORATE INTEGRATED DISTRICT DISTRICT DISTRICT HEALTH SERVICES PUBLIC HEALTH CLINICAL SERVICE DELIVERY SERVICE SYSTEM SPECIALISTS. OFFICE DISTRICT PLANNING, PAEDS MANAGER (12) PHARMACIST MONITORING & DDM: Clinical Programs O&G EVALUATION (12) PHC DDM: PME (12) FAMILY MEDICINE
DISTRICT PLANNER HRM TB CEO CEZA HOSPITAL DISTRICT SCM FINANCE HIV/AIDS
CEO NKONJENI DISTRICT HOSPITAL HRM COMMUNICATION PMTCT CEO BENEDICTI DISTRICT NE ENGINEER TRANSPORT HOSPITAL MCWH
CEO DISTRICT M&E VRYHEID HOSPITAL CHRONICS DIO CEO ITSHELEJUBA SCHOOL HOSPITAL DISTRICT QA
REHAB CEO ST FRANCIS DISTRICT CUBP HOSPITAL
NUTRITION CEO THULASIZWE HOSPITAL DISTRICT FLEET
COMMUNITY
CEO EDUMBE District OHS CDC CHC
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11.2 HUMAN Resources Current Deployment: Deployment of bursary holders was done at District Office in consultation with Hospital Managers to service delivery requirements.
Ceza Hospital was one of most hospital in need of doctors.
Previous Ceza Hospital was having three (3) doctors and one (1) clinical Associate, but with the recent January deployment, Ceza was given 4 additional doctors and two (2) clinical Associates, and they have also recruited another two (2) doctors more.
Therefore the stats stand at nine doctors (9) and three (3) clinical Associates.
The District office, together with Hospital Managers and Line Managers will continue to ensure that, service delivery is not compromised despite shortage of resources.
See the table below which reflect on Scarce Skills deployment for January 2015
No SURNAME INITIALS FIELD OF STUDY DISTRICT PLACED
1 MADONDO MS CLINICAL ASSO ZULULAND CEZA HOSP
2 SHABALALA NS CLINICAL ASSO ZULULAND CEZA HOSP
3 MTHETHWA SG DENTAL THERAPY ZULULAND BENEDICTINE HOSP 4 CELE SL MEDICINE ZULULAND CEZA HOSP
5 BUTHELEZI PF MEDICINE ZULULAND CEZA HOSP
6 NTSHANGASE SS MEDICINE ZULULAND CEZA HOSP
7 MVUYANA ZH MEDICINE ZULULAND CEZA HOSP
8 DLAMINI BG DENTISTRY ZULULAND VRYHEID HOSP
9 MNTUNGWA N MEDICINE ZULULAND ITSHELEJUBA
10 ZUNGU NS OCC THERAPY ZULULAND CEZA HOSP
11 XULU NK RADIOGRAPHY ZULULAND CEZA HOSP
12 MAGWAZA PS OCC THERAPY ZULULAND NKONJENI
13 SHELEMBE TN PHARMACY ZULULAND BENEDICTINE HOSP
14 MWANDLA A PHARMACY ZULULAND ST FRANCIS
15 DLAMINI DP PHARMACY ZULULAND CEZA HOSP
16 HLABISA T NURSING ZULULAND ITSHELEJUBA
17 DLAMINI NN NURSING ZULULAND BENEDICTINE HOSP CURRENTLY DOING INTERNSHIP Zulu PHARMACY 18 GP ZULULAND AT GAUTENG PROVINCE
19 MBULI S RADIOGRAPHY ZULULAND ST FRANCIS
20 NDLOVU N.C RADIOGRAPHY ZULULAND BENEDICTINE HOSP
21 ZWANE NC RADIOGRAPHY ZULULAND THULASIZWE
22 NTSHAYINTSHAYI S BCUR ZULULAND BENEDICTINE HOSP
23 MADONDO S.Z. AUDIOLOGY ZULULAND ITSHELEJUBA
24 MSIMANGO L.N. PHARMACY ZULULAND ITSHELEJUBA
25 GUMEDE TN PHYSIOTHERAPY MKHANYAKUDE ITSHELEJUBA
26 VILANA ZB PHYSIOTHERAPY ZULULAND VRYHEID HOSP
27 MTSHALI NW SPEECH THERAPY ZULULAND BENEDICTINE HOSP
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Staff recruitment and retention system and challenges
Recruitment of staff particularly doctors remain a challenge in the District although it has slightly improved, compared to the previous years. We also recognized the effort from our Partners on recruitment of scarce skills category, Africa Health Placement (AHP)
Current Status of doctors at various Zululand Health Districts
Institution 2014 2015
Ceza Hospital 3 9
Benedictine Hospital 9 22
Vryheid Hospital 12 20
Nkonjeni Hospital 17 17
Itshelejuba Hospital 9 9
Edumbe CHC 3 5
ST Francis Hospital 1 1
Retention of Staff
Zululand Health District is always committed to ensure that we recruit and retain our staff by providing the following:
Accommodation Capacitate staff, by providing training to improve their working skills Provide bursaries to our employees to further their studies to enhance working knowledge Create a healthy relation between Management and all levels of staff. Treat all employees equally without any discrimination.
Challenges
Poor and shortage of Staff accommodation Centralization of Skills Development budget Lack of communication at all levels. Improve quality of leadership Poor road infrastructure
ABSENTISM
Absenteeism is strictly monitored by HRM Circulars; this includes Leave Management project which was initiated by our Province. The following measures are in place to monitor absenteeism. Leave Management policies. Implementation and checking of attendance registers. Capturing of leave on Persal. Signing of leave Certificate
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STAFF TURN OVER Staff turnover has slightly increased recently following the rumours on pay out pension benefits, other employees opted to resigned and jobs elsewhere, but the situation has return to normally following seminars and workshops conducted by GEPRF. The other contributing factors that lead to increase staff turnover is the location of the District, because is deep rural, poor road infrastructure and shortage of staff accommodation.
Table 14: Staff type to Patient Ratio in Facilities [per 10 000] – Provincial Clinics
Sub-Districts MO to Patient PN to Patient EN to Patient ENA to Data General Provincial Provincial Provincial Patient Capturer to Worker to Clinics Clinics Clinics Provincial Patient Patient Clinics Provincial Provincial Clinics Clinics
Abaqulusi - 4160.7 7628.0 125861.3 251722.5 12908.8
Edumbe - 5247.0 4161.4 - 40226.7 15085.0
Nongoma - 5389.7 7397.6 17965.6 377278.0 29021.4
Ulundi - 3754.0 5350.5 155163.7 77581.8 17903.5
uPhongolo - 4893.4 6595.5 15968.1 33710.3 20226.2
Source: DHER 2013/14 Customised District Report
Table 15: Cost per Headcount in relation to Workload
Sub-Districts and District Total Staff Cost per PHC PN Workload Staff to Patient ratio at Headcount Provincial Clinics - PN
R 100 Abaqulusi 32 4160.7 R 211 Edumbe 31.9 5247.0 R 87 Nongoma 36 5389.7 R 126 Ulundi 24.4 3754.0 R 90 uPhongolo 35.8 4893.4 Source: DHER 2013/14 Customised District Report, DHIS
The PN workload for the district is 31.4 which is within the norm and has improved from 30.7 when compared to 2012/13. Apart from the CHC that has the highest cost per headcount, which is expected. Ulundi sub district has the highest cost per headcount after eDumbe and the lowest workload
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Table 16: PDE to District Hospital Staff Ratio
District Hospital PDE to Total PDE to Total PDE to Total PDE to Total PDE to Total Medical Staff Nursing Staff Pharmacy Staff Clinical Staff Support Staff ratio ratio ratio ratio ratio
Benedictine Hospital 10661.7 274.0 5330.9 6172.6 509.9
Ceza Hospital 14084.9 276.2 5281.9 4695.0 435.6
Itshelejuba Hospital 7696.2 306.3 5130.8 5597.3 306.3
Nkonjeni Hospital 10013.6 354.8 6932.5 6437.3 969.1
Vryheid Hospital 7536.1 368.2 5138.2 10276.5 942 Source: DHER 2013/14 Customised District Report The staff to PDE ratio for the medical staff is high for Ceza, Benedictine and Nkonjeni hospitals and is the highest among the other categories of staff, showing that there is need for medical staff.
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12. DISTRICT HEALTH EXPENDITURE
Table 17 (NDoH 9): Summary of District Expenditure
(Budget, Transfer to (Expenditure, (Expenditure, Transfer Data element (Budget, Province) (Budget, LG Own) (Expenditure, LG Own) LG) Province) to LG)
0.00 11 179 658.00 0.00 0.00 DF - 2.1: District Management 11 006 000.00 0.00
DF - 2.2: Clinics 304 699 000.00 0.00 0.00 304 990 447.00 0.00 0.00
DF - 2.3: Community Health Centres 42 416 000.00 0.00 0.00 43 163 646.00 0.00 0.00
DF - 2.4: Community Services 0.00 0.00 0.00 0.00 0.00 0.00
DF - 2.5: Other Community Services 67 617 000.00 0.00 0.00 69 170 371.00 0.00 0.00
DF - 2.6: HIV/AIDS 198 255 000.00 0.00 0.00 197 229 251.00 0.00 0.00
DF - 2.7: Nutrition 3 909 000.00 0.00 0.00 3 909 047.00 0.00 0.00
DF - 2.9: District Hospitals 703 016 000.00 0.00 0.00 718 039 650.00 0.00 0.00
DF – 2.12: Donor Funding
Source: DHER 13/14 District Customised Template
The expenditure on clinics has increased form R 277 284 616 in 2012 / 13 Financial Year to R 304 990 447 2013/14 by 9.8%. The expenditure on District
Hospitals has increased from R 675 194 034 in 2012/13 Financial Year to R 718 039 650 in 2013/14 Financial Year by 6%. The above- mentioned expenditure trend did not show and movement of expenditure from District Hospitals to PHC. The expenditure was only to sustain the services rather than additional services. HIV AND AIDS expenditure has increased form R164 480 649 in 2012/13 Financial Year to R 197 229 251 in 2013/14 by 16%
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Table 18 (NDoH 10): Capita PHC expenditure per sub-district – 2013/14
Sub-Districts Total Population District Service Delivery and District Expenditure PHC PHC % Uninsured % Cost per Cost per Expenditure Expenditure population Expenditure Uninsured Uninsured / Capita / Uninsured compared compared Capita Capita (Total Capita to District to District 2012/13 2013/4 Population)
Abaqulusi 82 521 114 R379 R405.3 93.50% 7.2% R674.1 R405.3
Edumbe 62 131 817 R739 R790.4 93.50% 1.7% R950.1 R790.4
Nongoma 61 556 592 R310 R331.7 93.50% 5.4% R513.7 R331.7
Ulundi 92 368 457 R480 R513.3 93.50% 7% R649 R513.3
uPhongolo 45 554 908 R347 R371 93.50% 4.2% R685 R371
Source: DHER 2013/14 Customised District Report, DHER 2011/12 and 2012/13
Table 19 (NDoH 11): PHC Budget and Expenditure (%) excluding “Other Donor Funding” – 2013/14
Budget Amount Budget Expenditure Amount Expenditure
District Management 11 006 000.00 0.7% 11 179 658.00 0.83% (2.1)
PHC (2.2 – 2.7) 616896000.00 26% 618462762.00 45.9%
District Hospitals (2.9) 703 016 000.00 45% 718 039 650.00 53.3%
Source: DHER 2013/14 Customised District Report
Table 20 (NDoH 12): PHC Cost per Headcount– 2013/14
LG PHC Facilities Provincial PHC Total Staff Cost per PHC Facilities Headcount
District N/A 68 R 114.6
Table 21: District Hospital Expenditure
District Hospital Expenditure per ALOS BUR Proportion (%) of PDE expenditure spent on staff (CoE)
Benedictine Hospital R1715 7.3 63.6 81.9%
Ceza Hospital R1962 7.4 51.5 81%
Itshelejuba Hospital R1596 6.0 81.4 78%
Nkonjeni Hospital R1480 7.5 81.1 80.6%
Vryheid Hospital R1467 4.8 68 79.7%
District R1644 6.6 69.12 78.1% Source: DHER 2013/14 Customised District Report
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Graph 6: District Hospital Expenditure in relation to Service Delivery – 2013/14
R 2 500
R 2 000
R 1 500 R1 300 R1 100 R 1 000 R1 000 R1 200 R1 400 R 500 R 541 R 606 R 685 R 291 R - R 187 Benedictine Ceza Itshelejuba Nkonjeni Vryheid
CoE / PDE Cost / GS
Source: DHER 2013/14 Customised District Report
Generally, the District has spent more on Compensation of Employees compared to the total amount spent on Goods and Services. Noted though, Nkonjeni Hospital showed high expenditure on Compensation of Employees and very low on Good and Services compared to the entire District Hospitals. Vryheid showed high expenditure both on Compensation of Employees and Goods and Services.
Table 22: Non-Negotiable Expenditure per PDE
Non-Negotiable [Rands per PDE] Benedictine Ceza Itshelejuba Nkonjeni Vryheid Hospital Hospital Hospital Hospital Hospital
Infrastructure Maintenance 1.5 0.0 0.0 0.0 0.0
Food Services 37.3 62.8 23.0 19.5 25.9
Medicine Expenditure 57.0 61.7 65.4 37.7 52.7
Medical Sundries (Supplies) 50.0 44.7 39.1 45.2 59.7 Expenditure
Essential Equipment 4.4 5.3 14.3 13.9 5.1
Laundry Expenditure 0.0 0.0 4.0 0.0 4.2
Vaccination Expenditure 2.9 2.6 1.0 1.8 3.0
Blood Support Expenditure 27.4 13.8 19.3 14.0 27.1
Infection Control Expenditure 24.7 19.9 50.7 40.7 21.8
Medical Waste Expenditure 9.0 8.9 7.4 10.1 11.9
Laboratory Services Expenditure 0.0 0.0 0.0 0.0 0.0
Security Services 10.5 33.5 47.6 33.7 16.6
Source: DHER 2013/14 Customised District Report
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PART B - COMPONENT PLANS
13. SERVICE DELIVERY PLANS FOR DISTRICT HEALTH SERVICES
13.1 SUB-PROGRAMME: District Health Services 13.1.1 PHC SUB-PROGRAMME OVERVIEW The PHC Facilities offer a comprehensive PHC service Package for i.e. preventive, promotive, curative and rehabilitative services at PHC. These services are provided at the fixed and mobile clinics and these are nurse driven but they also refer clients to the next level of care (CHC and district hospitals). At the community level there are Peer Educators (NGO) and Community Care Givers to render preventive, promotive services and home based care. These care givers receive referred clients from clinics and hospitals and they also refer to these facilities.
The district has 87 PHC facilities including 65 residential clinics, 3 gateway clinics, 19 mobile clinics (17 DOH& 2 State-subsidized), 1 State-subsidized clinic. Access to the health services is poor because there are still communities that are hard to reach and disadvantaged. The norm is 1PHC clinic per 10,000 populations, the district has an estimated population of 824 091, based on this, there is a deficit of 24 clinics, and Nongoma is the most underserviced sub-district, has a shortfall of 6 clinics, Abaqulusi 6, Edumbe 3, uPhongolo 4 and uLundi 1.
School health services provide preventive and promotive services that address health needs of school going children and youth with regard to both their immediate and future health. The programme support and facilitate learning through identifying and addressing health barriers to learning. It also supports the school community in creating a safe and secure environment for teaching and learning, (Health Promoting School). Zululand District has 14 school health teams (3 –Abaqulusi sub-district, 3 –Pongola sub-district, 2-Nongoma sub- district, 2-EDumbe sub-district and 4-Ulundi L/M.) Of 14 teams, only 8 are having dedicated school health vehicles. The district is having 741 schools to be attended to by the teams. Of 741, only 31 schools are accredited as health promoting schools The district has 6 Family Health Teams placed in Abaqulusi, Pongola, eDumbe and Ceza. Nongoma and Nkonjeni Hospital under Ulundi sub district are the only ones that do not have a Family health team.
PHC Utilization Rate This remains below the National and Provincial target, the District is at 2.6% a slight improvement when compared to last year. There were 4 clinics that were opened: 1 in
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Nongoma, 1 in Abaqulusi and 2 in uLundi sub district, though Nongoma still has the lowest utilization rate of 2.2 which has improved from 1.9.
PHC Supervisor visit rate PHC supervisor visit remains low but has improved from 72.3% to 84.2%. Ulundi and Edumbe sub districts were the lowest at 77.4% and 79.8% respectively, meanwhile Nongoma and Phongolo were above 90% transport remains a challenge. Mentoring and coaching was done aggressively to address the lack of competence in doing supervision due to lack of coaching & mentoring. The supervisors continue to fail to prioritize supervision above meetings.
Complaints Complaints have not been attended to in PHC. There has been no communication between the PROs and clinics, resulting in suggestion boxes not being opened.
Quality Assurance Quality Assurance Programme has been rolled out to all PHC facilities, assessed for compliance against the 6 priorities of the core standards, 100% of PHC Facilities with Quality Improvement Plans focusing on the 6 key focus areas. Percentage of PHC Facilities that conduct an Annual Satisfaction Survey once per annum is poor at 33.5% as a district. The major challenge is on analysis of data. There is inadequate support for Quality Programmes for PHC Facilities whereas hospitals get greater attention. Transport availability and long distances between PHC facilities is also a cause for concern.
STRATEGIC CHALLENGES: Low PHC utilisation rate Low PHC supervisor visit rate Poor complaints management at PHC Low coverage of PHC outreach teams (Family Health Teams and School Health Teams)
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Table 23 (NDoH 13): Situation Analysis: Indicators for District Health Services 2013/14 Financial Year
Type Abaqulusi 13/14 eDumbe Nongoma uLundi 13/14 uPhongolo 13/14 District Average 13/14 Indicators 13/14 13/14
1. District PHC expenditure per R R 405.30 R 790. 40 R 331.70 R 513. 30 R 371 R 482.34 uninsured person
Total expenditure on PHC services R’000 82 521 114 62 131 817 61 556 592 92 368 457 45 554 908 344 132 888
Number of uninsured people in the No 203 618.7 78 603.6 185 562 179 964.1 122 776.7 770 525.1 Province (Stats SA)
2. PHC utilisation rate (annualised) % 2.7 2.7 2.2 2.8 2.7 2.6
PHC headcount total No 569 785 231 106 444 730 529 450 351 567 2 126 638
Population Total No 217 774 84 068 198 462 192 475 131 312 824 091
3. OHH registration visit rate % New indicator New indicator New indicator New indicator New indicator New indicator
4. PHC supervisor visit rate (fixed % 87% 79.8% 92.1% 77.4% 90% 84.2% clinic/ CHC/ CDC)
PHC supervisor visit (fixed clinic/ No 160 57 139 226 108 690 CHC/ CDC)
Fixed clinics plus fixed CHCs/CDCs No 15 6 13 24 10 68
5. Complaint resolution within 25 % 0% 0% 0% 0% 0% 0% working days rate5
Complaint resolved within 25 No. 0 0 0 0 0 0 working days
Complaint resolved No. 0 0 0 0 0 0
6. Patient experience of Care % New indicator New indicator New indicator New indicator New indicator New indicator Survey rate
7. PHC Patient experience of Care % New indicator New indicator New indicator New indicator New indicator New indicator rate
8. Number of fully fledged District No 0 0 0 0 0 0 Clinical Specialist Teams appointed
5 In 2012/13 the indicator for Complaints resolved was monitored at PHC with no time limit therefore the data reflected is for Complaints resolved
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Type Abaqulusi 13/14 eDumbe Nongoma uLundi 13/14 uPhongolo 13/14 District Average 13/14 Indicators 13/14 13/14
9. Number of functional Ward No 2 1 0 1 2 6 Based Outreach Teams (Family Health Teams) (cumulative)
10. School ISHP coverage % 515 645 33.45% 63% 55% 56% (annualised)
Schools with any learner screened No 83 38 71 112 64 419
Schools - total No 164 90 212 160 116 741
11. School Grade 1 screening % 29% 47% 34% 38% 14% 32% coverage (annualised)
School Grade 1 learners No. 1973 1325 2352 2042 566 8258 screened
School Grade 1 learners - total No. 6851 2800 6889 5425 4070 26035
12. School Grade 4 screening % 35% 34% 32% 31% 26% 32% coverage (annualised)
School Grade 4 learners No. 1935 764 1719 1248 893 6559 screened
School Grade 4 learners - total No. 5556 2270 5389 4021 3411 20647
13. School Grade 8 screening % 13,5% 0,1% 5% 23,4% 10,2% 11% coverage (annualised)
School Grade 8 learners No. 768 4 304 990 454 2520 screened
School Grade 8 learners - total No. 5682 2279 6488 4229 4430 23108
14. Proportion of PHC facilities % 0 0 0 0 0 0 compliant with the extreme and vital measures of the National Core Standards for health facilities
PHC facilities compliant 0 0 0 0 0 0
Total PHC facilities 15 6 13 24 10 68
15. Number of Primary Health Care New indicator New indicator New indicator New indicator New indicator New indicator Clinics that qualify as Ideal Clinics
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Type Abaqulusi 13/14 eDumbe Nongoma uLundi 13/14 uPhongolo 13/14 District Average 13/14 Indicators 13/14 13/14
16. Number of Primary Health Care 14 6 13 24 10 67 Clinics with functional Clinic Committees
1 clinic in Abaqulusi did not have a functional clinic committee.
Table 24 (NDoH 14): District Performance Indicators – District Health Services
Audited/ Actual Performance Estimated Medium Term Targets Provincial Data Frequenc Performance Target Indicator Source y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. District PHC BAS/Stats SA Annual R 479.63 R658.80 R482.34 R511.12 R536.95 R564.09 R592.65 expenditure per R uninsured person
Total expenditure on BAS R’000 344 132 888 375 691 000 398 233 000 422 127 000 447 454 000 410416160.00 492349442.00 PHC services
Uninsured population DHIS/Stats No 606 451 728483 770525 735 039 741 655 748 330 755 005 in KZN SA
2. PHC utilisation DHIS Quarterly 2.3% 2.4% 2.6% 2.8% 2.7 2.9 3.1 3 rate (annualised) calculates Rate per person
PHC headcount total DHIS/PHC No 19 471 58 20 337 40 21 266 38 1 162 912 2 169 17 1 2 212 554 2 256 805 32 234 839 tick register
Population total DHIS/Stats Populatio 849 628 862 110 824 091 834 251 844 531 854 893 866 095 10 688 165 SA n
3. OHH registration DHIS Quarterly - - - 14,1% 14,5% 15% 20% 51.7% visit rate calculates %
OHH registration visit DHIS/Tick No - - - 2091 2500 2600 3000 62 422 register WBOT
OHH allocated to District No - - - 21600 21600 28800 36000 113 495 team Records
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Audited/ Actual Performance Estimated Medium Term Targets Provincial Data Frequenc Performance Target Indicator Source y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
4. PHC supervisor DHIS Quarterly 55% 72.3% 84.2% 73.7% 87.5% 96.2% 100% visit rate (fixed calculates % clinic/ CHC/ CDC)
PHC supervisor visit Supervisor No 399 573 690 320 725 820 840 (fixed checklists clinic/CHC/CDC)
Fixed clinics plus fixed DHIS No 756 756 828 828 828 840 840 CHCs/CDCs calculates
5. Complaint DHIS Quarterly 76.1% 64.9% 0% 85.5% 78.5% 86.4% 95% 90% resolution within calculates % 25 working days rate
Complaint resolved Complaint No 57 56 0 109 3 168 within 25 working days records
Complaint received6 No 73 74 0 193 3 520
6. Patient DHIS Annual Not Reported Not Reported New indicator New indicator experience of calculates % Care Survey rate
7. PHC Patient DHIS Annual Not Reported Not Reported New indicator New indicator 80% 90% 95% experience of calculates % Care rate
Patients satisfied with PSS results No 1010 1135 1200 health service
Patients participating PSS records No 1260 1260 1260 in PSS
8. PHC Total DHIS/Tick No 367677 376775 312 042 205 912 337 005 363 966 393 083 Headcount under register SHS 5 years
6 Changed from “resolved” to “received”
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Audited/ Actual Performance Estimated Medium Term Targets Provincial Data Frequenc Performance Target Indicator Source y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
9. Number of fully Persal/ Quarterly - 1 1 1 1 1 1 2 Complete fledged District District Teams and No the Clinical Specialist Records remaining 9 Teams teams with all nursing posts filled
10. Number of District Quarterly 3 5 6 6 7 8 9 20 functional Ward Manageme No Based Outreach nt/ Persal Teams appointed (Family Health Teams)(cumulativ e)
11. School ISHP DHIS Quarterly 53% 55% 56% 22% 57.9% 59.4% 60.9% coverage calculates % (annualised)
Schools with any DHIS/Tick No 350 477 419 160 450 500 550 learner screened register SHS
Schools - total DHIS/DOE No 525 525 741 741 741 756 756 database
12. School Grade 1 DHIS Quarterly 26% 23% 32% 19% 34.5% 51.8% 77.6% 55% screening calculates % coverage (annualised)
School Grade 1 DHIS/Tick No 11 352 13 199 8258 5031 - learners screened register SHS
School Grade 1 DHIS/DOE No 12 634 13 199 26035 26105 26105 26205 29335 - learners - total database
13. School Grade 4 DHIS Quarterly - - 32% 17% 40% 45% 50% screening calculates % coverage (annualised)
School Grade 4 DHIS/Tick No - - 6559 3718 learners screened register SHS
School Grade 4 DOE No - - 20647 22346 22446 22556 22600 learners - total database
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Audited/ Actual Performance Estimated Medium Term Targets Provincial Data Frequenc Performance Target Indicator Source y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
14. School Grade 8 DHIS Quarterly - - 11% 5.1% 15% 20% 25% 40% screening calculates % coverage (annualised)
School Grade 8 DHIS/Tick No - - 2520 1169 - learners screened register SHS
School Grade 8 DOE No 23108 22908 23000 23105 23200 - learners - total database
15. Proportion of QA Quarterly - - 0 0 7.2% 14.5% 22% clinics compliant assessment % with extreme and records vital measures of the National Core Standards for health facilities
PHC facilities QA No 0 0 0 0 5 10 15 compliant assessment records
Total PHC facilities DHIS No 63 63 68 68 69 69 69 calculates
16. Number of - - - New indicator 10 15 20 119 Primary Health To establish Care clinics that baseline qualify as Ideal Clinics
17. Number of 63 62 68 68 69 69 69 Primary Health Care clinics with functional clinic committees
Indicator 3 [Outreach households]: The province is not yet reporting on the indicator and information system not yet activated.
Indicator 8 [DCST]: Due to numerous challenges with recruitment and retention of team members, it was proposed that teams will be appointed per Region to ensure improved support and governance. This is therefore not in line with the national target of full teams per district by 2019.
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Indicator 10 [School ISHP Coverage]: The number of schools will be reviewed annually depended on Educations data based.
Indicators 11, 12 &13 [Screening of Grade 1, 4 & 8 learners]: There is no data to inform projections.
This will be reviewed once the baseline has been established.
Indicator 4 [Supervision]: Projections (denominator) based on commissioning of new clinics and therefore dependent on project completion.
Table 25 (Table 15): District Specific Objectives and Performance Indicators – District Health Services
Estimated Audited/ Actual Performance Medium Term Targets Strategic Data Frequency Performance Performance Indicators Objective Source Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Increase the PHC 1. PHC utilisation rate DHIS Quarterly 3.5 3.6 3.7 4.0 3.8 3.9 4.0 utilisation rate under 5 years calculates % under 5 years to (annualised) 5 visits per child by March 2020 PHC headcount DHIS/PHC No 367677 376775 312 042 205 912 337 005 363 966 393 083 under 5 tick register
Population under 5 DHIS/Stats No 804 392 814 129 102 426 102 440 102 145 101 781 101 628 years SA
Increase the 2. Expenditure per PHC DHIS/BAS Quarterly R128 R154.7 R185 R323 R183.59 R190.87 R198.27 expenditure per headcount R PHC headcount to R 330 by Total expenditure BAS (R’000) R’000 4 104 161 4 923 494 618462762.0 375 691 000 398 233 000 422 127 000 447 454 000 March 2020 PHC 60 42 0
PHC headcount DHIS No 1 954 753 2 033 740 2 126 638 1 162 912 2 169 17 1 2 212 554 2 256 805 total calculates
Increase School 3. Number of School District Quarterly 12 13 14 14 14 15 15 Health Teams to Health Teams Records/ No at least 246 by (cumulative) Persal March 2020
Increase the 4. Number of Health Quarterly 20 28 31 31 37 43 49 accredited accredited Health Promotion No Health Promoting Promoting Schools database Schools to 380 by (cumulative) March 2020 as part of PHC re- engineering
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Estimated Audited/ Actual Performance Medium Term Targets Strategic Data Frequency Performance Performance Indicators Objective Source Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Improve 5. Dental extraction to DHIS Quarterly 1004:1 447:1 26.7 26.9 efficiencies in restoration ratio calculates Ratio dental health by reducing the Tooth extraction DHIS/Tick No 31087 37286 36636 14 368 - - - dental extraction register to restoration ratio to less than Tooth restoration DHIS/Tick No 5663 6801 11793 535 - - - 13:1 by March register 2020
To implement 6. Percentage of PHC QA Annual - - 52% 60% 80% 100% the facilities conditionally assessment % National Core compliant to the records Standards for National Core Quality in Standards 100% of Clinics conditionally QA No 0 0 36 42 55 69 facilities compliant (50%- assessment towards 75%)to National Core records accreditation Standards of 50% PHC clinics and CHC’s and clinics DHIS No 67 69 69 69 70 70 70 100% CHC’s by total calculates 2015/16
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13.1.2 District Health Services: Strategies /Activities to be implemented 2015/16
Strategies Activities
1. PROs, IPC and Quality Clinical Programme Managers to Each PHC Facility to have at least 1 visit per quarter. Monthly support visit plans and reports to be submitted to prioritise PHC facilities for support. PHC Managers and District Quality Coordinator
2. Increase PHC utilisation rate Extend hours of service in some clinics from 8hours to 10hours; have some clinics operating for 24hrs. Awareness of availability of clinics offering extended hours Ensure that each clinic has allocated medical officer visiting regularly Intensify functionality of Phila mntwana Centres where screening and referral to be done Increase WBOT that will screen and identify children for referral at household level. Increase number of war-room visit for health service marketing and health needs identification 3. Increase PHC Supervisor visit Ensure the availability of transport for PHC Supervision (encourage staff to use their own vehicles if suitable and be paid according to policies) Ensure that all post are filled under the PHC services and proper allocation / distribution of staff within the district 4. Improve access of outreach teams Motivate for transport for Family and School Health Teams
5. Ensure that clinics qualify as Ideal clinic Intensify implementation of QIPs Do quarterly assessments of progress on QIPs 6. Improve Information Management Include Data Management in Performance Agreements of all Managers at all levels Training and mentorship of Facility staff on Indicators and data elements Distribution and use of relevant data collection tools Monthly sub-district performance review. Monthly District performance reviews.
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13.2 Sub-Program: District Hospitals 13.2.1 Sub-Programme Overview To provide quality district hospital services, which include: Emergency medical services, adult and child in- and out-patients, obstetric care as well as effectively run pharmaceutical service, to conduct quality surveys to improve service delivery?
Strategic Challenges: • Inadequate human resource distribution, recruitment and retention. • Poor hospital efficiencies, e.g. high ALOS. • Inadequate management capacity and development and mentoring programs. • Poor utilization of PHC services leading to increase in outpatient head count not referred new. • Inadequate monitoring and evaluation of all programs. • Poor infrastructure that does not cater for increasing programs. • Poor integration of services
Table 26 (NDoH 16): Situational Analysis Indicators for District Hospitals – 2013/14 Financial Year
Indicators Type Benedictine Ceza Hospital Itshelejuba Nkonjeni Hospital Vryheid Hospital District Average Hospital Hospital
1. Average length of stay - total Days 7.3 7.4 6.0 7.5 4.8 6.6
In-patient days No 89 080 30 083 45 467 68 077 83 818 316 525
Day patients No 70 5 549 15 123 762
Inpatient separations No 12 182 4 050 7 607 9 078 17 438 50 355
2. Inpatient bed utilisation rate - total % 63.6% 51.5% 81.4% 81.1% 68% 66.2%
In-patient days No 89 080 30 083 45 467 68 077 83 818 316 525
Day patients No 70 5 549 15 123 762
Inpatient bed days available No 117 530 56 210 86 140 123 370
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Indicators Type Benedictine Ceza Hospital Itshelejuba Nkonjeni Hospital Vryheid Hospital District Average Hospital Hospital
3. Expenditure per PDE R R1715 R1962 R1596 R1480 R1467 R1644
Expenditure total R’000 R203 694 402 R85 120 590 R99 828 753 R135 517 389 R170 034 669 R694 195 803
Patient day equivalent No 117 279 42 255 64 039 90 122 113 041 424 268
4. Complaints resolution within 25 % 30.8% 74% 0.0% 100% 100% 40% working days rate
Complaints resolved within 25 days No 16 26 02 1 5 30
Total number complaints received No 24 35 05 1 10 75
5. Number of District Mental Health No New indicator New indicator New indicator New indicator New indicator New indicator Teams established
6. Patient experience of Care rate % New indicator New indicator New indicator New indicator New indicator New indicator
No
No
7. Percentage of hospitals that have No 100% 100% 100% 100% 100% 100% conducted gap assessments for compliance against the National Core Standards
District Hospitals that conducted self- No 1 1 1 1 1 4 assessments
Number of District Hospitals No 1 1 1 1 1 5
8. Proportion of District Hospitals % 0 0 0 0 0 0 compliant to all extreme measures of National Core Standards
District Hospitals compliant No 0 0 0 0 0 0
District Hospitals total No 1 1 1 1 1 5
9. Compliance Rate of National Core % 0 0 0 0 0 0 Standards
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Indicators Type Benedictine Ceza Hospital Itshelejuba Nkonjeni Hospital Vryheid Hospital District Average Hospital Hospital
10. Number of district hospitals with No 1 1 1 1 1 5 functional boards
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Table 27 (NDoH 17): Performance Indicators for District Hospitals
Audited/ Actual Performance Estimated Medium Term Targets Provincial Frequenc Indicator Data Source Performance Target y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1 Average length of DHIS Quarterly 6.4 6.1 6.6 6.5 6 5.9 5.9 5.8 Days stay- total calculates Days
In-patient days Midnight No 310 143 304 382 316 525 182 101 326 021 335 801 345 875 2 049 076 census
Day patients Midnight No 139 195 762 757 800 842 880 11 865 census
Inpatient separations DHIS No 48 304 50 111 50 355 27 977 52 520 54 779 57 134 348 922 calculates
2 Inpatient bed DHIS Quarterly 68.9% 66.1% 66.2% 65.3% 67.8% 69.4% 71.2% 64.7% utilization rate – total calculates %
In-patient days Midnight No 310 143 304 382 316 525 182 101 326 021 335 801 345 875 2 049 076 census
Day patients Midnight No 139 195 762 757 800 842 880 11 865 census
Inpatient bed days available Manageme No 20 610 21 107 441 650 441 650 441 650 441 650 3 173 310 nt
3 Expenditure per BAS/DHIS Quarterly R1 370 R1 549 R1 644 R3 272 R1 425 R1 259 R1 112 R 1 808 patient PDE R
Expenditure total BAS R’000 R1 317 291 R1 451 971 R694 195 803 R801 383 000 R849 467 R900 435 000 R954 461 000 5 309 057 036 251 000
Patient day equivalent DHIS No 774 263 833 579 496 803 244 941 596 164 715 396 858 476 2 935 044 calculates
4 Complaint resolution within DHIS Quarterly - 78% 40% 85.5% 80% 90% 100% 85% 25 working days rate %
Complaint resolved within 25 PSS No - 57 30 109 1 785 days
Complaint received PSS No - 73 75 193 2 100
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Audited/ Actual Performance Estimated Medium Term Targets Provincial Frequenc Indicator Data Source Performance Target y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
5 Number of District DHIS Quarterly New New New New 1 1 1 indicator indicator Mental Health Teams calculates No indicator indicator established
6 Patient experience of Care DHIS Annual New New New New 85% 90% 95% indicator indicator indicator indicator rate calculates %
7 Proportion of hospitals QA/DHIS Quarterly - 100% 80% 60% 100% 100% 100% that have conducted calculates % gap assessments for compliance against the National Core Standards
District Hospitals self-assessed QA No - 5 4 3 5 5 5 for compliance assessment records
District Hospitals total DHIS No - 5 5 5 5 5 5 calculates
8 Proportion of District QA/DHIS Quarterly - 0 0 0 40% 60% 80% 14% Hospitals compliant to calculates % all extreme measures of National Core Standards
District Hospitals fully compliant QA No - 0 0 0 2 3 4 5 (75%-100%) to all extreme assessment measures of National Core records Standards
District Hospitals total DHIS No - 5 5 5 5 5 5 37 calculates
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Audited/ Actual Performance Estimated Medium Term Targets Provincial Frequenc Indicator Data Source Performance Target y Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
9 Compliance Rate of QA/DHIS Quarterly - 0 0 0 40% 60% 80% National Core calculates % Standards
District Hospitals compliant to QA No - 0 0 0 2 3 4 National Core Standards assessment records
District Hospitals total DHIS No - 5 5 5 5 5 5 calculates
10 Compliance Rate of 0 0 0 0 80% 90% 95% National Core Standards
11 Number of District 5 5 5 5 5 5 5 Hospitals with functional boards
Table 28 (NDoH 18): District Strategic Objectives and Annual Targets for District Hospitals
Estimated Strategic Audited/ Actual Performance Medium Term Targets Frequency Performance Objective Performance Indicator Data Source Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Reduce the 1. Delivery by caesarean DHIS Quarterly caesarean section 21.5% 24.2% 22.9% 21.9% 22.2% 21.5% 20.9% section rate calculates % rate to 25% (or less) by March 2020 Delivery by caesarean Delivery No 3 107 3 525 3 735 1902 3 650 3 600 3 550 section register Delivery in facility total Delivery No 16 614 16 276 16 343 8 700 16 450 16 500 16 650 register
Reduce un referred 2. OPD headcount- total DHIS/OPD tick Quarterly OPD headcounts 221032 322124 290 953 175 264 282 224 273 758 265 545 register No
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Estimated Strategic Audited/ Actual Performance Medium Term Targets Frequency Performance Objective Performance Indicator Data Source Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
with at least 7% per 3. OPD headcount not DHIS/OPD tick Quarterly 71 205 72 483 10 0891 36 187 94 838 89 147 83 798 annum referred new register No
To implement the 4. Proportion of District QA / DHIS Quarterly 0 0 0 0 40% 60% 80% National Core Hospitals conditionally calculates % Standards in 100% compliant to National of Core Standards facilities towards District Hospitals conditionally accreditation of QA No 0 0 0 0 2 3 4 compliant assessment 100% District records Hospitals by District Hospitals Total 2014/15 DHIS No 5 5 5 5 5 5 5 calculates
13.1.3 District Hospitals: Strategies /Activities to be implemented 2015/16
Strategies Activities
1. Inadequate human resource distribution, recruitment and Revamp structures making them attractive retention: Re- visit staff retention strategies
Strengthen working relations with private sectors to assist with recruitment processes Equitable distribution of community service professionals Proper distribution of skills within the district 2. Improve Poor hospital efficiencies Motivate and recruit more doctors Strengthen and review referral system Identify dedicated high care beds in all district hospitals Identify step-down beds. 3. Improve performance on National Core Standards Motivate staff Do self-assessment audits
Monitor the progress, identify gaps and have action plans
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14. HIV & AIDS & TB CONTROL (HAST)
14.1 Programme Overview HAST is a communicable disease programme looking at HIV, AIDS, STI and TB. It comprises of the following sub programmes.
Prevention strategies
o HCT
o Male medical circumcision
o Condom distribution
o TB screening and testing
o IPT
o CPT
Treatment and support o ART o TB management and support o STI treatment
Strategic challenges
o Low condom distribution coverage
o Low MMC coverage
o Low paediatric HIV testing and HAART initiation.
o High number of clients on ART who are lost to follow up
o Reduced number of facilities using TIER as a monitoring system
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Table 29 (NDoH 19): Situational Analysis Indicators for HIV & AIDS, STI’s and TB Control - 2013/14 Financial Year
Indicator Type Abaqulusi Edumbe Nongoma uLundi uPhongolo District Average
1. Total clients remaining on ART at No 19 255 6 482 13 879 14 716 12 096 66 428 end of the month
2. Number of men and women 15 No 41 373 11 739 36 639 46 866 18 855 155 472 – 49 years tested for HIV
3. Number of men medically No 1 668 1 366 2 000 2 014 887 7 935 circumcised
4. Number of male condoms No. 1 613 364 406 968 1 750 267 3 252 431 876 573 7 899 603 distributed
5. Number of female condoms No. 107 019 27 606 62 940 99 820 20 494 317 879 distributed
6. Number of people screened for 9960 3876 8785 23 225 4631 50 477 TB
7. TB new client treatment success % 81.3% 86.2% 81.5% 75.9% 82.5% 81.4% rate
TB client cured OR completed No 90 50 54 83 70 359 treatment
TB (new pulmonary) client No 467 165 255 460 258 1605 initiated on treatment
8. TB (new pulmonary) defaulter % 3.6% 2.1% 4.8% 2.0% 6.9% 3.8% rate
TB(new pulmonary)treatment No 7 0 0 1 5 13 defaulter
TB(new pulmonary)client initiated No 467 165 255 460 258 1605 on treatment
9. TB AFB sputum result turn-around % 71.1% 49% 82.6% 74.7% 60.4% 71.3% time under 48 hours rate
TB AFB sputum result received No 15 493 1 891 7 625 20 639 5 864 51 512 within 48 hours
TB AFB sputum sample sent No 21 790 3 860 9 230 27 634 9 703 72 217
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Indicator Type Abaqulusi Edumbe Nongoma uLundi uPhongolo District Average
10. TB treatment initiation rate % 96.% 99% 82% 98% 87% 93% (annualized)
TB client initiated on treatment No. 467 165 255 460 258 1605
TB confirmed new client No. 485 167 310 469 296 1727
11. HIV testing coverage (15 – 49 % 34.9% 27.2% 37.1% 47.3% 26.8% 36.2% years) (annualised)
HIV test client 15-49 years No 41 373 11 739 36 639 46 866 18 855 155 472
Population 15-49 years No 117 856 42 881 98 304 98 514 69 970 427 525
12. TB (new pulmonary) cure rate % 81.3% 86.2% 81.5% 75.9% 82.5% 81.4%
TB (new pulmonary) client cured No 90 50 54 83 69 358
TB (new pulmonary) client No 467 165 255 460 258 1605 initiated on treatment
13. TB MDR confirmed treatment % 100% 100% 100% 100% 100% 100% initiation rate
TB MDR confirmed client initiated on No. 44 4 45 59 26 178 treatment
TB MDR confirmed new client No. 44 4 45 59 26 178
14. Number of professional nurses No. 02 0 0 0 0 02 trained to initiate MDR TB.
15. MDR Treatment success rate % 72% 67% 60% 53% 58% 62%
MDR TB client cured or completed No 54 4 16 41 22 137 treatment
MDT TB client initiated on treatment No 101 9 52 81 37 280
16. TB Death Rate % 9% 4.6% 8.0% 11% 4.8% 7.4%
TB client death during treatment No 20 1 8 12 5 46
TB(new pulmonary) client initiated on No 98 9 39 91 35 272 treatment
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Table 30 (NDoH 20): Performance Indicators for HIV & AIDS and TB Control
Indicator Data Source Frequen Audited/ Actual Performance Estimated Medium Term Targets Provincial cy Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Total clients remaining on TIER Quarterly 42 592 54 454 66 428 71 122 72 015 82 818 95 240 1 276 200 ART at end of the month No
2. Number of men and women DHIS Quarterly 199 408 190 122 155 472 79 055 164 800 174 688 185 170 15 – 49 years tested for HIV No
3. Number of men medically DHIS Quarterly 5 213 6 584 7 935 5 213 9601 10 562 11 618 631 374
circumcised No
4. Number of male condoms DHIS Quarterly 4,398,518 6,128,634 7 899 603 4 930 335 8 689 563 9 558 520 10 514 372 212 mil
distributed No
5. Number of female condoms DHIS Quarterly Not Not reported 317 879 134 545 340 660 374726 408792 3 500 000 distributed No reported
6. Number of people screened ETR. Quarterly Not Not reported 50 477 14 710 15 000 16 000 for TB No reported
7. TB new client treatment ETR Quarterly 79.8% 78.3% 81.4% 84.7% 88.1% 91.6% 85% success rate %
TB client cured OR TB register 1 678 1 203 359 32 257 completed treatment
TB (new pulmonary) client TB Register 2 142 2 096 1605 37 949 initiated on treatment
8. TB (new pulmonary) ETR Quarterly 5.1% 2.9% 3.8% 3.5% 2.7% 2.6% 2.6% 3.9% defaulter rate %
TB(new pulmonary)treatment TB register No 111 61 66 50 1 530 defaulter
TB(new pulmonary)client TB Register No 2142 2096 1605 1400 38 255 initiated on treatment
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Indicator Data Source Frequen Audited/ Actual Performance Estimated Medium Term Targets Provincial cy Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
9. TB AFB sputum result turn- ETR.Net Quarterly 81.6% 78.7% 71.3% 76.3% 83.3% 85.5% 87.9% 85% around time under 48 hours calculates % rate
TB AFB sputum result TB register No 73 643 70 839 51 512 13 763 60 000 909 281 received within 48 hours
TB AFB sputum sample sent TB Register No 90 195 89 990 72 217 18 043 75 000 1 069 742
10. TB treatment initiation rate ETR.Net Quarterly Not Not reported 97% 98% 99% 100% 100% (annualized) calculates % reported
TB client initiated on treatment TB register No 1605 1570 1480 1300 1200
TB confirmed new client TB Register No 1727 1600 1500 1300 1200
11. HIV testing coverage (15 – 49 DHIS Quarterly 95.6% 96.2% 36.2% 36.2% 36.7% 37.1% 37.6% 59.4% years) (annualised) calculates %
HIV test client 15-49 years DHIS/Tick No 199 408 190 122 155 472 79 055 169 056 185 962 216 927 3 384 862 register PHC & Counsellor
Population 15-49 years DHIS/Stats Populati 104 645 104 012 427 525 436 783 446 076 455 674 466 035 5 697 177 SA on
12. TB (new pulmonary) cure ETR.Net Quarterly 78.3% 82.4% 81.4% 85% 89.1% 92.7% 96.4% 85% rate calculates %
TB (new pulmonary) client TB register No 1 678 1 203 358 1175 1415 1475 1528 31 310 cured
TB (new pulmonary) client TB Register No 2 142 2 096 1605 1400 1600 1590 1580 36 835 initiated on treatment
13. TB MDR confirmed treatment ETR.Net Quarterly 75.1% 91.6% 100% 100% 100% 100% 100% 60% initiation rate calculates %
TB MDR confirmed client initiated TB register No 187 263 178 160 150 140 130 - on treatment
TB MDR confirmed new client TB Register No 249 287 178 160 150 140 130 -
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Indicator Data Source Frequen Audited/ Actual Performance Estimated Medium Term Targets Provincial cy Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
14. Number of professional No. - - 02 06 10 20 30 nurses trained to initiate MDR TB.
15. MDR Treatment success rate ETR.Net Quarterly 34% 56% 62% 63% 65% 70% 75% 60.9% calculates %
MDR TB client cured or TB register No 137 171 189 205 219 - completed treatment
MDT TB client initiated on TB Register No - - 280 270 290 290 290 - treatment
16. TB Death Rate ETR.Net Annual 8.0% 6.6% 7.4% 7.1% 7.0% 6% 3% 4% calculates %
TB client death during TB Register No 171 97 107 115 20 17 9 1 140 treatment
TB(new pulmonary)client No 2142 2096 1605 1600 290 290 290 28 500 initiated on treatment
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Table 31 (NDoH 21): District Strategic Objectives and Annual Targets for HIV & AIDS
Estimated Audited/ Actual Performance Medium Term Targets Strategic Data Frequency Performance Performance Indicator Objective Source Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
1. Number of patients that ETR.Net Annual 298 254 383 320 290 290 290 started regimen iv calculates No treatment (MDR-TB)
Maintain the 2. MDR-TB Six month interim ETR.Net Annual 63% 75% 70% 70% 72% 75% 78% MDR-TB six month outcome calculates % interim outcome at 85% (or more) Number of patients with a No 130 190 204 133 208 219 227 from March 2018 negative culture at 6 onwards months who started treatment for 9 months
Total patients who started No 202 254 383 190 290 290 290 treatment in the same period
Improve Drug 3. Number of patients that ETR.Net Annual Not Not Not Not available Not Not Not Resistant TB started XDR-TB treatment calculates No available available available available available available outcomes by ensuring that 90% (or more) diagnosed MDR/XDR-TB patients are initiated on treatment by March 2020
Increase the XDR- 4. XDR-TB Six month interim ETR.Net Annual Not Not Not Not available Not Not Not TB six month outcome calculates % available available available available available available outcome to 80% by March 2020 Number of clients with a No ------negative culture at six months who has had started treatment for 9 months
Total of patients who No ------started treatment in the same period
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Estimated Audited/ Actual Performance Medium Term Targets Strategic Data Frequency Performance Performance Indicator Objective Source Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Reduce the TB 5. TB incidence (per 100 000 ETR.Net Annual 123 98 92 90 90 88 86 incidence to 400 population) No per per 100 000 (or 100,000 less) by March 2020 New confirmed TB cases ETR.Net No 10 527 8 461 7 514 7 514
Total population in KZN DHIS/Stats SA Population 855 674 862 110 824 091 834 251 844 531 854 893 866 095
Reduce the HIV 6. HIV incidence (annual) ASSA2008 Annual incidence to 1% % (or less) by March - 2.5 2.5 - 2.3 1.9 1.6 2020 (ASSA2008 estimates)
Decrease the STI 7. STI treated new episode DHIS Quarterly 6.2 6.8 65.1 59.3 63.4 67.8 72.4 incidence to 9/ incidence (annualised) calculates No per 1000 1000 by March
2020 STI treated new episode DHIS/Tick No 33 050 36 222 34 173 15 794 34 443 37 546 40 909 register PHC/ casualty
Population 15 years and DHIS/Stats Population 393 301 504 314 522 144 532 792 543 272 553 785 565 046 older SA
Increase the male 8. Male condom distribution DHIS Quarterly 16.9 23.1 33.6 41.2 40.3 48.4 58.1 condom coverage(annualised) calculates Rate per distribution rate to male 150 condoms per male per year by Male condoms distributed DHIS/Stock No 4,398,518 6,128,634 7 899 603 4 930 335 8 689 563 9 558 520 10 514 372 March 2020 cards
Population 15 years and older DHIS/Stats Population 223 029 228 700 234 105 239 394 244 623 249 903 255 422 male SA
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14.2 HIV & AIDS, STI & TB CONTROL (HAST): Strategies/ Activities to be implemented 2015/16
Strategies Activities
1. Low MMC coverage Increase the number of roving MMC teams to reach all areas within the district Strengthen the awareness campaigns and utilize all relevant stakeholders Proper allocation of budget and all other relevant resources for the program Strengthen and maintain relationships with private partners 2. Low condom distribution rate Ensure a systematic flow of distribution (obtain from central point and distribute) Identify areas that will be used as storage sites and ensure that there is efficient monitoring of stock Ensure availability of male and female condom at all times. Motivate for additional contracted condom provider. Distribute condoms in all sites e.g. Taverns, Taxi ranks, public toilets in shopping malls. Conduct education campaigns on effective use of male and female condoms. Provide dildos at all facilities to ensure proper demonstration and usage. Address social and cultural norms that are barriers to condom use.
3. Low paediatric HIV testing and HAART Scale up HCT and PICT for children initiation. Improve systematic clinical management of Paediatric and Adolescent ART patients to strengthen follow-up and retention in care- Implement approved new Paediatric and Adolescent ART clinical stationery.
Scale up both HIV testing in children and ART initiation through already trained clinicians. Set target for Paediatric NIMART trained nurses and monitor implementation: HIV testing in children <15 years. ART initiation in children <15 years.
4. Reduced number of facilities using TIER as Intensify signing off of facilities a monitoring system Strengthen audits of clinical charts
5. Increased number of new MDR cases Train PHC nurses on NIMDR (nurse initiated MDR treatment diagnosed within the district. Train mentor doctors on MDR management Train sub districts TB coordinators on MDR management Train CCGs on MDR management Procure 6 Kudu waves for audio monitoring of MDR patients Procure 4 park homes for 4 established satellites sites namely Itshelejuba, Nkonjeni, Edumbe CHC and Benedictine hospitals Procure 6 , 4x4 double caps vehicles for injection teams
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Strategies Activities Appoint 4 additional enrolled nurses for MDR injection teams Appoint 4 PHC nurses for NIMDR as operational managers Procure 4 dinamaps, 4 HGT machines, 4 patella harmers, 4 examination sets, 4 foot scales, 4 examination couches to examine MDR patients
ensure screening of TB patients in all service points 6. Improve case finding Conduct TB investigation from all TB suspects identified using Gene expert Ensure all TB cases are initiated on TB treatment within 5 days following diagnosis. Ensure TB screening is done in correctional services, ,hostels, FETs and schools
7. Improve TB cure rate to 85% and above Manage all TB cases according to National TB guidelines Train all nurses on management of TB Train CCGs on DOT Ensure defaulters are traced
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15. MATERNAL, NEONATAL, CHILD AND WOMEN’S HEALTH AND NUTRITION
15.1 PROGRAMME Overview Purpose of MCWH PMTCT and Nutrition Programme is to reduce maternal and child mortality. It also aims at improving women and adolescent health. The MCWH plan is informed by DERE, NSP, PAP and 16+2 interventions. Primary health approach to promote healthy life style, prevention of diseases, early, quality antenatal and post natal care services infant and child services implementation of CARMMA strategies in all institutions, implementation of KZN5 point contraceptive strategies and establishment of CTOP services.
STRATEGIC CHALLENGES:
o High Maternal mortality
o High child under five mortality
o HIV Retesting uptake of pregnant mothers low
o low Immunisation coverage o Inadequate access to ART due to insufficient health service coverage
o Low ANC Clients initiated on ART rate o Late booking of pregnant women o ART Default/poor adherence for Pregnant women o Mixed feeding o Inadequate adherence to ART /PMTCT Guidelines o Inadequate access to ART due to insufficient health service coverage o Insufficient knowledge to the community
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Table 32 (NDoH 22): Situational Analysis Indicators for MCNWH & N – 2013/14 Financial Year
Indicator Type Abaqulusi Edumbe Nongoma uLundi uPhongolo District Average
1. Immunisation coverage under 1 % 94.7% 78.7% 63.8% 86.5% 81.3% 80.6% year (annualized) Immunised fully under 1 year new No 4 632 1 648 3 710 4 309 2 731 17 030 Population under 1 year Pop 4 900 2 099 5 821 4 993 3 364 21 177
2. Vitamin A dose12 – 59 months % 67.4% 37% 47.6% 44.5% 33.7% 48.3% coverage (annualized) Vitamin A dose 12 - 59 months No 26 407 6 215 20 067 17 209 8 683 78 591 Population 12-59 months (multiplied No 9796 4 196 11 090 9826 6584 41 492 by 2)
3. Deworming dose 12-59 months % 44.5% 35.6% 32.2% 34.3% 30.4% 35.7% coverage (annualised)
Deworming dose 12-59 months No. 17 436 5 982 13 592 13 259 7 829 58 098
Population 12-59 months (multiplied Pop 9796 4 196 11 090 9826 6584 41 492 by 2) 4. Child under 2 years underweight No per 8.4 3.8 6.3 5.9 5.9 6.4 for age incidence (annualised) 1000 Child under 2 years underweight - No 82 16 71 58 39 266 new (weight between - 2SD and - 3SD new) Population under 2 years No 9 798 4 197 11 366 9 906 6 656 41 923
5. Measles 1st dose under 1 year % 92.1% 84.7% 65.5% 87.7% 81.6% 81.4% coverage (annualised0
Measles 1st dose under 1 year No 4 900 2 099 5 821 4 993 3 364 17 201
Population under 1 year Pop 4 900 2 099 5 821 4 993 3 364 21 177
6. DTaP-IPV/Hib 3 to Measles 1st % 0.5% 5.5% 13.5% 2.6% 7.9% 5.9% Dose drop-out rate DTaP-IPV/Hib3 to Measles 1st Dose No 24 103 594 118 234 1073 drop-out
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Indicator Type Abaqulusi Edumbe Nongoma uLundi uPhongolo District Average
DTaP-IPV/Hib 3rd dose No 4 531 1 878 4 402 4 489 2 974 18 274
7. Measles 2nd dose coverage % 74.3% 75.5% 61.4% 74.4% 70% 70.3%
Measles 2nd dose No 3 637 1 584 3400 3 654 2 301 14 576
Population under 2years Pop 9 798 4 197 11 366 9 906 6 656 41 923
8. PCV 3rd dose coverage % 91.6% 83.4% 67.5% 88.7% 81.5% 81.9% (annualized) PCV 3rd dose No 4 484 1748 3926 4 418 2 735 17 311
Population under 1 year Pop 4 900 2 099 5 821 4 993 3 364 21 177
9. RV 2nd dose coverage % 92.8% 90.7% 75.3% 90.1% 87.6% 86.3% (annualised) RV 2nd dose No 4 540 1900 4 379 4 490 2 942 18 251 Population under 1 year Pop 4 900 2 099 5 821 4 993 3 364 21 177
10. Cervical cancer screening % 62.7% 116.5% 47.8% 119.9% 62.1% 78.5% coverage (annualised) Cervical cancer screening in women No 2535 1769 1649 4244 1395 11 592 30 years and older Population 30 years and older Pop 40 631 15 073 34 267 35 119 22 293 147 383 female/10
11. HPV 1st Dose (HPV vaccine % 85.5% 88.4% 96.3% 92.1% 76.9% 87.8% coverage amongst Grade 4 girls )
HPV vaccine Grade 4 girls No 2204 855 2057 2290 1418 8824
Total number of girls reached No 2577 967 2135 2483 1843 10005
12. Antenatal 1st visits before 20 % 62.2% 56.7% 60.4% 56.9% 52.2% 58.3% weeks rate Antenatal 1st visit before 147 weeks No 3 169 1136 2991 2932 1714 11 942
Antenatal 1st visit total No 5 148 2 003 4 951 5 151 3 284 20 537
7 “Before 20 weeks”
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Indicator Type Abaqulusi Edumbe Nongoma uLundi uPhongolo District Average
13. ANC Clients initiated on ART rate % 97.5% 85% 92.2% 74.1% 78.2% 85.8% Antenatal client initiated on ART No 1371 469 992 922 836 4590 Antenatal client eligible for ART No 1 423 552 1 076 1 244 1 069 5 364
14. Infant given NVP within 72 hours % 99% 99.7% 99.9% 71.5% 97.8% 93% after birth uptake rate 8 Infant given NVP within 72 hours after No 1503 318 1492 825 452 4590 birth Live birth to HIV positive woman No 1518 319 1493 1144 462 4936
15. Proportion of mothers visited New indicator New indicator New indicator New indicator New indicator New indicator within 6 days of delivering their babies Numerator No ------Denominator No ------
16. Infant 1st PCR test positive around % 2.1% 0.9% 1.8% 1.6% 3.2% 2% 6 weeks rate Infant 1st PCR test positive around 6 No 37 5 29 24 39 134 weeks Infant 1st PCR test around 6 weeks No 1731 573 1609 1576 1205 6694
17. Couple year protection rate % 36.5% 30.3% 33.7% 48.3% 30.1% 37% (annualized) Contraceptive years dispensed9 No 21 311 6806 18 408 26 530 10 925 83 980
Population 15-44 years female Pop 55 269 20 821 50 729 50 199 33 982 211 000
18. Maternal mortality in facility No per 65.4 0 100.1 265.3 101.2 124.2 ratio (annualized) 100K Maternal death in facility No 3 0 4 10 3 20
Live birth in facility No 4588 789 3995 3887 2964 16 223
8 Baby Nevirapine uptake rate 9 This data is from DHIS and not from the closed-off DHIS data file, as this data element was only introduced in 2013/14
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Indicator Type Abaqulusi Edumbe Nongoma uLundi uPhongolo District Average
19. Delivery in facility under 18 % 11.8% 5.6% 10.8% 9.4% 9.6% 10.3 years rate Delivery in facility to woman under No 542 44 434 377 280 1682 18 years Delivery in facility total No 4595 791 4021 4142 2910 16 459
20. Child under 1 year mortality in No Per 1 13.9 - 12.9 19.1 6.7 12.3 facility rate (annualized) K Inpatient death under 1 year No 69 - 77 98 23 267
Population estimated live births No 4588 789 3995 3770 2964 16 223
21. Inpatient death under 5 years No Per 1 5.2 - 12.9 7.1 6.5 7.3 rate K Inpatient death under 5 years No 77 - 102 109 43 331
Inpatient separations under 5 years No 1490 66 781 1531 656 4 524
22. Child under 5 years severe % 34.8% - 30.8% 26.8% 11.1% 26.9% acute malnutrition case fatality rate Child under 5 years severe acute No 8 - 20 11 3 42 malnutrition death Child under 5 years severe acute No 23 - 65 41 27 156 malnutrition admitted
23. Child under 5 years diarrhoea % 4.9% - 3.5% 7.1% 4.7% 5.1% case fatality rate Child under 5 years with diarrhoea No 16 - 8 19 9 52 death Child under 5 years with diarrhoea No 324 - 231 266 191 1 012 admitted
24. Child under 5 years pneumonia % 3.7% - 5.0% 7.1% 8.7% 6.5% case fatality rate Child under 5 years pneumonia No 5 - 2 8 15 30 death Child under 5 years pneumonia No 134 - 40 113 173 460 admitted
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Indicator Type Abaqulusi Edumbe Nongoma uLundi uPhongolo District Average
25. Delivery in facility rate % 88.9% 35.3% 64.7% 75.5% 81.0% 72.5%
Delivery in facility total No 4595 791 4021 4142 2910 16 459
Population estimated deliveries Pop 5 243 2246 6 228 5 343 3 599 22 659
26. Infants exclusively breastfed at % 39.7% 34.4% 28.2% 37.6% 40.6% 36% Hepatitis B 3rd dose Infant exclusively breastfed at HepB No 1 800 649 1 232 1 680 1 209 6 570 3rd dose HepB 3rd dose No 4 530 1 885 4 374 4 469 2 981 18 239
Table 33 (NDoH 23): Performance Indicators for MCWH&N
Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Immunisation coverage DHIS Quarterly 77.0% 77.0% 80.6% 88.6% 90% 94.1% 96.7% 90% under 1 year % (annualized)
Immunised fully under 1 year new DHIS/Tick No 16 792 16 474 17 030 9321 18 640 19 151 19 460 193 933 register PHC
Population under 1 year DHIS/Stats SA Population 20 999 21 069 21 177 21 041 20 712 20 374 20 125 215 481
2. Vitamin A dose12 – 59 DHIS Quarterly 29.5% 28.9% 48.3% 63.2% 65.6% 69.9% 70.9% 60% months coverage % (annualized)
Vitamin A dose 12 - 59 months DHIS/Tick No 51 761 52 502 78 591 51 477 80 949 81 501 83 377 1 072 060 register PHC
Population 12-59 months DHIS/Stats SA Population 41146 41 322 41 492 41 416 411 10 40 780 40 564 1 786 768 (multiplied by 2)
3. Deworming dose 12-59 DHIS Quarterly Not Not 35.7% 50.6% 51% 53% 55% months coverage % Reported Reported (annualised)
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Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Deworming dose 12-59 months DHIS/Tick No - - 58 098 41 183 20 966 21 613 22 310 register PHC
Population 12-59 months DHIS/Stats SA Population 41146 41322 41192 41416 41110 40 780 40 564 (multiplied by 2)
4. Child under 2 years DHIS Annual Not Not 6.4 12.5 6.1 5.7 5.2 underweight for age PER 1K Reported Reported incidence (annualised)
Child under 2 years underweight - DHIS/Tick No - - 266 261 2517 2 324 2 101 new (weight between - 2SD and - register PHC 3SD new)
Population under 2 years DHIS/Stats SA Population 41 572 41 732 41 923 41 749 41 267 40 764 40 407
5. Measels 1st dose under 1 DHIS Quarterly 63.5% 63.2% 81.4% 94.9% 85.6% 89.4% 94.3% year coverage % (annualised0
Measles 1st dose under 1 year DHIS/Tick No 17 527 16 963 17 201 9 988 17 476 17 756 18 040 register PHC
Population under 1 year DHIS/Stats SA Population 20999 21069 21177 21041 20712 20374 20 125
6. DTaP-IPV/HIV 3 Measles DHIS Quarterly Not Not 5.9% -1% 5.5% 4.8% 4.2% 7% st 1 Dose drop-out rate % Reported Reported
DTaP-IPV/Hib3 to Measles 1st Dose DHIS/Tick No 1 073 -100 1009 883 775 - drop-out register PHC
DTaP-IPV/Hib 3rd dose DHIS/Tick No 18 274 9 888 18 350 18 400 18 450 - register PHC
7. Measles 2nd dose DHIS Quarterly Not Not 70.3% 99.3% 76% 84% 92% 85% coverage % Reported Reported
Measles 2nd dose DHIS/Tick No 14 567 10 287 31 362 34 241 37 174 183 159 register PHC
Population under 2years DHIS/Stats SA No 41 572 41 732 41 923 41 749 41 267 40 764 40 407 215 481
8. PCV 3rd dose coverage DHIS Quarterly 75.7% 76% 81.9% 92.7% 83% 85.5% 88% (annualized) %
PCV 3rd dose DHIS/Tick No 16 869 16 923 17 311 9 754 17 190 17 317 17 710 register PHC
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Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Population under 1 year DHIS/Stats SA Population 20 999 21 069 21 177 21 041 20 712 20 374 20 125
9. RV 2nd dose coverage DHIS Quarterly 77.9% 79.1% 86.3% 90.9% 86.4% 87% 89% (annualised) %
RV 2nd dose DHIS/Tick No 18 026 17 907 18 251 9 559 17 895 17 725 17 911 register PHC
Population under 1 year DHIS/Stats SA Population 20 999 21 069 21 177 21 041 20 712 20 374 20 125
10. Cervical cancer screening DHIS Quarterly 73.9% 76% 78.5% 65.7% 79.7% 81.6% 83.6% 75% coverage (annualised) %
Cervical cancer screening in DHIS/Tick No 10 879 10 654 11 592 4 988 12 056 12 538 13 039 175 671 women 30 years and older register PHC
Population 30 years and older DHIS/Stats SA Population 129 689 132 677 147 382 151 958 156 680 161 095 166 096 234 228 female/10 11. HPV 1st Dose (HPV vaccine DHIS Quarterly New New 88.1% 90% 93.4% 95% 85% coverage amongst Grade 4 % indicator indicator girls ) HPV vaccine Grade 4 girls DHIS/Tick No 8824 9090 9527 9737 - register PHC
Total number of girls reached DHIS/Tick No 10005 10100 10200 10 250 - register PHC
12. Antenatal 1st visits before 20 DHIS Quarterly 37.7% 37.7% 58.3% 59.8% 60.2% 63.5% 65.1% 60% weeks rate %
Antenatal 1st visit before 20 weeks DHIS/Tick No 3 414 4 565 11 942 5 959 12 610 13568 14 187 139 012 register PHC
Antenatal 1st visit total DHIS/Tick No 19151 19410 20537 9962 20948 21367 21794 231 686 register PHC
13. ANC Clients initiated on DHIS Quarterly Not Not 85.8% 97.2% 90% 100% 100% 95% ART rate % reported reported
Antenatal client initiated on ART DHIS/Tick No 4590 2 385 4500 5500 5700 - register PHC
Antenatal client eligible for ART DHIS/Tick No 5 364 2 453 5000 5500 5700 - register PHC
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Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
14. Infant given NVP within DHIS Quarterly 98.2% 89.8% 93% 93.7% 95.3% 97.7% 100% 72 hours after birth % uptake rate 10
Infant given NVP within 72 hours DHIS/Tick No 5 562 5 024 4590 2 516 5 003 5 453 5 944 after birth register OPD/ PHC, delivery register
Live birth to HIV positive woman DHIS/Delivery No 5 786 5 646 4936 2 685 5 150 5400 5944 register
15. Proportion of mothers DHIS Quarterly New New New New 56.7% 62.3% 68.5% indicator indicator indicator visited within 6 days of % indicator delivering their babies Establish baseline
Numerator No - - -
Denominator No - - -
16. Infant 1st PCR test positive DHIS Quarterly 4.6% 4.8% 2% 2.1% 1.7% 1.4% 1.2% <1% around 6 weeks rate %
Infant 1st PCR test positive around DHIS/Tick No 239 165 134 76 113 92 79 905 6 weeks register PHC
Infant 1st PCR test around 6 weeks DHIS/Tick No 6 497 6 650 6 694 3 641 6 650 6600 6590 90 535 register PHC
17. Couple year protection DHIS Quarterly 24.6% 24.6% 37% 38.9% 38% 42.7% 47.8% 55% rate (annualized) %
Contraceptive years dispensed11 DHIS No 56 438 68 992 83 980 44 806 83 395 95 438 108 909 1 611 360 calculates
Population 15-44 years female DHIS/Stats SA Population 202 078 206 601 211 000 215 322 219 461 223 510 227 844 2 929 745
10 Baby Nevirapine uptake rate 11 This data is from DHIS and not from the closed-off DHIS data file, as this data element was only introduced in 2013/14
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Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
18. Maternal mortality in DHIS Annual 93.0/100 000 88.2/100 000 124.2/100 92/100 000 92/100 000 90/100 000 85/100 000 120/100 000 facility ratio 000 (annualized)
Maternal death in facility DHIS/Midnight No 25 18 20 8 15 14 10 242 census
Live birth in facility DHIS/Delivery No 16 596 16 130 16 223 8700 16 324 16 519 16 769 202 473 register
19. Delivery in facility under DHIS Quarterly 8.9% 8.9% 10.3% 10.7% 9.8% 9.5% 9.0% 18 years rate %
Delivery in facility to woman under DHIS/Delivery No 1 791 1 758 1682 930 1627 1593 1524 18 years register
Delivery in facility total No 16 614 16 276 16 459 8700 16 603 16 769 16 937
20. Child under 1 year DHIS Annual 12.8 12.7 12.3 18.2 12.0 11.8 11.5 mortality in facility rate Per 1k (annualized)
Inpatient death under 1 year DHIS No 183 262 267 197 195 194 184 calculates
Population estimated live births DHIS No 16 596 16 130 16 223 8700 16 324 16 519 16 718 calculates
21. Inpatient death under 5 DHIS Quarterly 7.7% 7.6% 7.5% 8.4% 7.3% 7.2% 7.0% years rate calculates %
Inpatient death under 5 years DHIS No 300 419 331 257 309 297 285 calculates
Inpatient separations under 5 DHIS No 3 973 4 284 4524 3069 4233 4132 4082 years calculates
22. Child under 5 years DHIS Quarterly 21.3% 19.2% 26.9% 19.0% 26% 24.3% 21.3% 8% severe acute calculates % malnutrition case fatality rate
Child under 5 years severe acute DHIS/Tick No 44 27 42 19 26 24 21 256 malnutrition death Register
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Indicators Data Source Frequency Audited/ Actual Performance Estimated Medium Term Targets Provincial Type Performance Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Child under 5 years severe acute Admission No 237 140 156 100 100 100 100 3 200 malnutrition admitted records
23. Child under 5 years DHIS Quarterly 8.5% 5.0% 5.1% 5.5% 4.8% 4.7% 4.6% 3.2% diarrhoea case fatality calculates % rate
Child under 5 years with diarrhoea DHIS/Tick No 50 43 52 30 39 37 36 329 death Register
Child under 5 years with diarrhoea Admission No 622 901 1 012 541 807 798 788 10 224 admitted records
24. Child under 5 years DHIS Quarterly 6.3% 6.1% 6.5% 5.1% 6.1% 6.0% 5.9% 2.4% pneumonia case fatality % rate
Child under 5 years pneumonia DHIS/Tick No 40 29 30 15 25 23 18 227 death Register
Child under 5 years pneumonia Admission No 670 511 460 292 426 387 313 9 199 admitted records
25. Delivery in facility rate DHIS Quarterly Not Not 72.5% 77.3% 77.5% 80.2% 82.6% % reported reported
Delivery in facility total No 16 459 8 700 17 175 17 483 17 787
Population estimated deliveries No 22 469 22 544 22 659 22 513 22 162 21 800 21 534
26. Infants exclusively DHIS Quarterly 17.2% 58.9% 36% 39.1% 61.3% 62.5% 63.8% breastfed at Hepatitis B % 3rd dose
Infant exclusively breastfed at Tick Register No 3 115 10 177 6 570 3 844 11 515 12 093 12 715 HepB 3rd dose PHC
HepB 3rd dose No 18 141 18 185 18 239 9 840 18 786 19 350 19 930
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Table 34 (NDoH 24): District Objectives and Annual Targets for MCWH & N
Audited/actual Performance Estimated Strategic Medium Term Targets Frequency Performance Objective Performance Indicators Data Source Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Reduce the 1. Infant mortality ASSA2008 Annual ------30.5/1000 infant rate Rate per mortality rate 1000 to 29 per 1000 live births by March 2020
Reduce the 2. Under 5 mortality ASSA2008 Annual ------42/1000 under 5 rate Rate per mortality rate 1000 to 40 per 1000 live births by March 2020
Reduce 3. Child under 5 DHIS Annual 18.2 13.7 12.6 6.0 12.0 11.7 10.8 under-5 years diarrhoea calculates Rate per diarrhoea with dehydration 1000 with incidence dehydration (annualised) incidence to less than 9.5 Child under 5 years PHC Tick No 1 775 1 327 1 290 305 1 226 1 191 1 098 per 1000 by diarrhoea with Register March 2020 dehydration new
Population under 5 DHIS/Stats SA Population 101 768 102 100 102 426 102 440 102 145 101 781 101 628 years
Reduce the 4. Child under 5 DHIS Annual 99 72.7 51.7 51.3 50.1 45.7 37 under-5 years pneumonia calculates Rate per pneumonia incidence 1000 incidence to (annualised) less than 80 per 1000 by Child under 5 years PHC Tick No 9 614 7 072 5 296 2 626 5 117 4 651 3 760 March 2020 with pneumonia new Register
Population under 5 DHIS/Stats SA Population 101 768 102 100 102 426 102 440 102 145 101 781 101 628 years
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Audited/actual Performance Estimated Strategic Medium Term Targets Frequency Performance Objective Performance Indicators Data Source Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Reduce 5. Child under 5 DHIS Annual 4.6 5.8 3.7 4.0 3.5 3.3 3.0 severe acute years severe calculates Rate per malnutrition acute malnutrition 1000 incidence incidence under 5 years (annualised) to 4.6 per 1000 by Child under 5 years DHIS/Tick No 452 594 374 203 357 335 305 March 2020 with severe acute register PHC malnutrition new
Population under 5 DHIS/Stats SA Population 101 768 102 100 102 426 102 440 102 145 101 781 101 628 years
Reduce the 6. Child under 1 year DHIS Annual/ 12.8 12.7 12.3 18.2 12.0 11.8 11.5 child under 1 mortality in facility Per 1k year rate (annualised) mortality in facility rate Inpatient death under DHIS No 183 262 267 197 195 194 184 to less than 1 year calculates 4% by March 2020 Inpatient separations DHIS No 16 596 16 130 16 223 2120 16 324 16 519 16 718 under 1 year calculates
Reduce the 7. Inpatient death DHIS Annual/ 7.7 7.6 7.5 8.4% 7.3% 7.2% 7.0% inpatient under 5 year rate % death under- 5 rate to less Inpatient death under DHIS No 300 419 331 257 309 297 285 than 4% by 5 years calculates March 2020 Inpatient separations DHIS No 3973 4 284 4524 3069 4233 4132 4082 under 5 years calculates
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15.2 STRATEGIES/ Activities to be implemented 2015/16
Strategies Activities
1.Reduction of maternal mortality Ensure clear protocols and skills training on the management of PROM(Pre-term rupture of membranes) and relevant drugs ( e.g. tocolytics, steroids, antibiotics Further scale up of ESMOE training and ensure fire drills are conducted Improve case management in MOUs and hospitals through ensuring availability of SOPs, training and mentoring and regular maternal mortality review meetings Strengthen PICT by ensuring that midwives counsel and test all pregnant women in labour whose HIV status is unknown or who tested negative more than 12 weeks previously Access to reproductive health Family planning campaigns Intensify 16+2 intervention e.g. clean birth practices Improve management of labour and delivery Improve basic antenatal care –ANC booking before 20 weeks Improve management of obstetric emergencies(ESMOE) Community linkages(Siyanqoba) Promote HIV Retesting uptake of pregnant mothers Integration of MCWH with HIV Aids and TB Regular auditing of patient folders, to improve the quality of care of women during labour and delivery, especially with regards to the justification of caesarean sections performed 2. Reduction of under-five child mortality Improve rotavirus vaccine coverage Improve case management of children with dehydration at PHC using IMCI (including zinc) Improve case management in hospitals though availability of guidelines, training and supervision and mortality review IMCI management and training Training health workers for HBB Improve immunisation coverage e.g. RED Strategies and Campaigns Improve skills on resuscitation of a neonate Ensure that health systems supports are in place
3. Increase access to ART Facilitate Scale up of FDC roll-out to HIV positive pregnant women Strengthen data management for PMTCT/FDC Ensure dissemination of the revised PMTCT guidelines and SOPs to all facilities, and strengthen training, mentorship and supervision of NIMART trained nurses to ensure effective implementation of these guidelines and SOPs
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Strategies Activities
4.Monitor adherence to ART Strengthen counselling to ensure improvement of patient adherence and reduction of loss to follow-up, to eliminate transmission especially via breastfeeding, and to keep mothers alive (HCW, Health promotion, WBOTS functions) Improve on tracing system to prevent loss to follow up
3. Improve immunisation coverage district to identify all sub-districts below 80% fully Immunised and target them with: – Give Catch Up doses: Use WBOTs, Facility Committee & HP messages – Use Immunisation Coverage Monitoring & Response – Defaulter Tracing – Use WBOT & HP. To assign the District EPI Coordinator and the DIO verify and sign off data at per facility in accordance with DQSA.
4. Counsel on feeding methods Give health education on feeding option each time they visit a health facility
5. Create community awareness on on ART/PMTCT Programme Mobilise community through OSS and CCG, Community dialogues Involvement of NGOS Introduce revised ART/PMTCT Guidelines to the community at large to get buy in IEC material to be updated to include Family Planning, and to be made accessible to communities, especially pregnant mothers Draft main community radio messages. Involve Primary Health Care and WBOTs Involve Health Promotion and Communication Draft flyers for WBOTs, Health Promotion, Community leaders, clinic committees to distribute
6. Capacitate health care workers on ART/PMTCT Guidelines Train HCW on revised ART/PMTCT guidelines Monitor and mentor HCW on implementation of revised ART/PMTCT guidelines
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16. DISEASE PREVENTION AND CONTROL (ENVIRONMENTAL HEALTH INDICATORS)
16.1 PROGRAMME Overview Environmental Health (EH) is the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health. It is a field of science that studies how the environment influences human health and diseases. Environment in this context means identifying and addressing how the environment impacts human health. EH addresses all the physical, chemical and biological factors external to a person, and all the related factors impacting behaviours.
Strategic challenges
o High incidence of diabetic and hypertension rate
o Increasing number of people with mental illness – due to high unemployment rate leading to substance abuse
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Table 35 (NDoH 25): Situational Analysis for Disease Prevention and Control - 2013/14 Financial Year
Indicator Type Abaqulusi Edumbe Nongoma uLundi uPhongolo District Avg
1. Hypertension incidence (annualised)12 No per 1000 16.1 12.5 8.0 9.9 11.9 11.7
Hypertension client treatment new No 647 195 271 340 262 1715
Population 40 years and older No 41 706 15 548 33814 34 285 21 839 147 192
2. Number of people counselled and screened for high No. New indicator New indicator New indicator New indicator New indicator New indicator blood pressure data not collected
3. Diabetes incidence (annualised) No per 1000 1.0 1.4 0.2 0.5 0.6 0.7
Diabetes client treatment new No 209 122 49 94 73 547
Population 40 years and older No 41 706 15 548 33814 34 285 21 839 147 192
4. Number of people counselled and screened for New indicator New indicator New indicator New indicator New indicator New indicator raised blood glucose levels
Numerator No
Denominator No
5. Percentage of people screened for mental disorders % New indicator New indicator New indicator New indicator New indicator New indicator
Numerator No
Denominator N0
6. Percentage of people treated for mental disorders % New indicator New indicator New indicator New indicator New indicator New indicator
Numerator N0
Denominator No
7. Proportion of health facilities accessible to people % 100% 100% 100% 100% 100% 100% with disabilities
Numerator No 16 7 14 28 11 76
Denominator No 16 7 14 28 11 76
12 This calculation was done manually and was not automatically calculated by DHIS
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Indicator Type Abaqulusi Edumbe Nongoma uLundi uPhongolo District Avg
8. Proportion of health facilities providing rehabilitation % 31% 14% 42% 50% 36% 40% services
Numerator No 5 1 6 14 4 30
Denominator No 16 7 14 28 11 76
9. Number of Health Districts providing community No based rehabilitation
10. Malaria case fatality rate % 0.0 0.0 0.0 0.0 0.0 0.0
Number of deaths due to malaria (new) No 0 0 0 0 0 0
Number of malaria cases (new) No 0 0 0 0 0 0
11. Cataract surgery rate No per million 0.0 0.0 0.0 0.0 0.0 0.0 uninsured population
Cataract surgery total No 0.0 0.0 0.0 0.0 0.0 0.0
Population uninsured total No 303 618 78 603 185 562 179 964 122 776 772 525
Table 36 (NDoH 26): Performance Indicators for Environmental Health Services
Estimated Provincial Frequency Audited/ Actual Performance Medium Term Targets Data Source Performance Targets Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Hypertension incidence DHIS calculates Quarterly 22.7 17.6 13.5 13.7 13.0 12.8 11.5 18.9/ 1000 13 (annualised) Per 1000
Hypertension client treatment DHIS/PHC & No 3307 2579 1715 1 066 1975 1977 1812 48 140 new OPD tick registers
Population 40 years and older DHIS/Stats SA Population 142 799 144 917 147 192 149 551 151 990 154 530 157 605 2 547 127
13 This calculation was done manually and was not automatically calculated by DHIS
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Estimated Provincial Frequency Audited/ Actual Performance Medium Term Targets Data Source Performance Targets Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
2. Number of people New New New New Establish - - - indicator indicator indicator indicator baseline counselled and screened for high blood pressure
3. Diabetes incidence DHIS calculates Quarterly 0 0.7 1.6 1.5/1000 (annualised) Per 1000
Diabetes client treatment new DHIS/PHC & No 1114 808 1020 628 1 000 1 183 1 373 16 032 OPD tick registers
Population 40 years and older DHIS/Stats SA Population 142 799 144 917 147 175 149 551 151 990 154 530 157 605 10 688 165
4. Number of people DHIS QUARTELY New New New New Establish - - - indicator indicator indicator indicator baseline counselled and screened % for raised blood glucose levels
Numerator DHIS/PHC & No ------OPD tick registers
Denominator No ------
5. Percentage of people DHIS QUARTELY New New New New Establish - - - indicator indicator indicator indicator baseline screened for mental % disorders
Numerator DHIS/PHC & No ------OPD tick registers
Denominator No ------
6. Percentage of people DHIS QUARTELY New New New New Establish - - - indicator indicator indicator indicator baseline treated for mental % disorders
Numerator DHIS/PHC & No ------OPD tick registers
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Estimated Provincial Frequency Audited/ Actual Performance Medium Term Targets Data Source Performance Targets Type 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Denominator No ------
7. Proportion of health QUARTELY 100% 100% 100% 100% 100% - facilities accessible to % people with disabilities
Numerator No 76 76 77 77 77 -
Denominator No 76 76 77 77 77 -
8. Proportion of health QUARTELY 40% 60% 80% 100% - facilities providing % rehabilitation services
Numerator No 30 46 62 77
Denominator No 76 77 77 77
9. Number of Health Districts - - - - 1 1 1 providing community based rehabilitation
10. Malaria case fatality rate Malaria register Annual 0 0 0 0 0 0 0 0.5% Rate
Number of deaths due to Malaria No 0 0 0 0 0 0 0 - malaria (new) register/Tick sheets PHC
Number of malaria cases (new) Malaria No 17 6 0 0 0 0 0 - register/Tick sheets PHC
11. Cataract surgery rate DHIS calculates Quarterly 0 0 0 184.6 930/ 1mil No per 1mil uninsured population
Cataract surgery total DHIS/Theatre No 0 0 0 47 150 250 300 8 895 register
Population uninsured total DHIS/Stats SA Population 606 451 728 483 724 172 735 039 741 655 748 330 755 005 9 566 487
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Table 37 (NDoH 27): District Objectives and Annual Targets for Environmental Health Services
Strategic Estimated Frequency Audited/ Actual Performance Medium Term Targets Objective Performance Indicator Data Source Performance Type Statement 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Zero new 1. Malaria incidence Malaria Annual 0 0 0 0 0 0 0 local per 1000 population register Per 1000 malaria at risk population cases by at risk March 2020 Number of malaria cases Malaria No 17 03 0 0 0 0 0 (new) register/Tick register PHC
Population Zululand DHIS/Stats SA Population 855 674 862 110 824 091 834 251 844 531 854 893 866 095
16.2 STRATEGIES/ Activities to be implemented 2015/16
Strategies Activities
1. Reduce incidence of Diabetes Promote healthy lifestyle through physical activities on Mpilonde Clubs and support groups
Conduct diabetic workshops to all sub districts 2. Reduce incidence of Health education on importance of taking treatment as prescribed Hypertension Reduction of salt in diet through awareness
3. Counselled & screened Strengthen counselling & screening of people people for Diabetes & Education session on obesity and overweight hypertension
4. Reduce Mental health Strengthen community awareness on effects of alcohol and drug abuse disorders Strengthen health education on how to deal with problems
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17. INFRASTRUCTURE, EQUIPMENT AND OTHER SUPPORT SERVICES
Table 38 (NDoH 38): Performance Indicators for Health Facilities Management
Indicator Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Expenditure on facility maintenance as % of total district % 1.3% 3% 3% 3% 3% 3% 3% 1.3% health expenditure
Numerator 13 813 937 17 341 718 15 716 192 22 051 000 25 000 000 28 000 000 31 000 000 13 813 937
Denominator 17 936 000 17 407 000 15 594 000 22 051 000 25 000 000 28 000 000 31 000 000 17 936 000
2. Number of facilities that have undergone major and minor 4 11 6 1 8 7 7 refurbishment
3. Fixed PHC facilities with access to continuous supply of % 83% 100% 100% 100% 100% 100% 100% clean portable water
Numerator 63 64 68 68 69 69 69
Denominator 64 64 68 68 69 69 69
4. Fixed PHC facilities with access to continuous supply of % 100% 100% 100% 100% 100% 100% 100% electricity
Numerator 63 63 68 68 69 69 69
Denominator 63 63 68 68 69 69 69
5. Fixed PHC facilities with access to sanitation 100% 100% 100% 100% 100% 100% 100%
Numerator 64 64 68 68 69 69 69
Denominator 64 64 68 68 69 69 69
6. Fixed PHC facilities with access to fixed telephone line % 60% 66% 70% 70% 80% 90% 100%
Numerator 38 42 48 48 55 62 69
Denominator 63 63 68 69 69 69 69
7. Percentage of PHC facilities with network access 0 0 0 0 25% 50% 75%
Numerator 0 0 0 0 17 35 52
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Indicator Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Denominator 63 63 68 68 69 69 69
8. Number of additional clinics and community health 2 5 3 0 0 0 0 centres constructed
Maintenance expenditure is not spent as per planned due to poor performance from contractors and lack of capacity on the deriving the specifications from the institutions. Most of our facility do not comply to National Core Standard hence they need to be upgraded for them to be accredited for implanting the NHI All facility have access to water however those that are getting water from Municipality scheme had the challenge of water cut and the reservoir are not enough to sustain 48hrs back up supply. Sanitation has improved to all facilities however at Njoko clinic the toilets are being replaced since the Municipality toilets do not meet DOH standard. Most facilities in the rural areas do not have telephones since lines and poles had been stolen however the recent build clinic are using the satellite lines
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18. SUPPORT SERVICES
This section of the DHP addresses the support services, which enable health workers to operate and provide the actual health services, namely:
Pharmaceutical services;
Equipment and Maintenance; and
Transport and EMRS.
18.1 PHARMACEUTICAL SERVICES Table 39 (NDoH 39): Pharmaceutical Services Performance Indicators
Indicators Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Percentage of institutions % 71% 83% 83% 100% 100% 100% 100% 100% (District Hospitals and CHC’s) with functional of Pharmaceutical and Therapeutics Committees (PTC’s)
Number of CHC’s and District 4 5 5 6 6 6 6 6 Hospitals with functional Pharmaceutical and Therapeutic Committees
Number of District Hospitals and 6 6 6 6 6 6 6 6 CHC’s
2. Any ARV Drug Stock Out % 14% 10% 5% <1% <1% <1% <1% Rate
Number of ARV drug’s out of 2 3 2 0 0 0 0 stock
Number of ARV’s drugs 28 30 30 30 30 30 30
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Indicators Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
3. Any TB Stock Out Rate % 13% 10% <5% <1% <1% <1% <1%
Number of TB drugs out of stock 5 2 0 0 0 0 0
Number of TB drugs 19 19 19 7 19 19 19
4. Percentage of Hospitals % 80% 80% 100% 100% 100% 100% 100% with Pharmacists
Number of District Hospitals with 4 5 5 5 5 5 5 Pharmacists
Number of District Hospitals 5 5 5 5 5 5 5
5. Percentage of CHC’s with % 100% 100% 100% 100% 100% 100% 100% Pharmacists
Number of CHC’s with 1 1 1 1 1 1 1 pharmacists
Number of CHC’s 1 1 1 1 1 1 1
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Table 40 (NDoH 30): Pharmaceutical Services
Estimated Audited/ Actual Performance Medium Term Targets Strategic Objective Performance Indicator Data source Type Performance 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
1. Percentage of Pharmacy Annual 50% 38% 38% 100% 88% 100% 100% Pharmacies that records % obtained A and B grading on inspection
Pharmacies with A or B Pharmacy No 4 3 3 8 8 8 Grading records
Number of pharmacies Pharmacy No 8 8 8 8 8 8 8 records
2. Tracer medicine Pharmacy Quarterly 16.10% 11% 21.70% <5% <1% <1% <1% stock-out rate records % (PPSD)
Number of tracer Pharmacy No 7 5 3 0 0 0 0 medicine out of stock records
Total number of tracer Pharmacy No 43 43 43 43 43 43 43 medicine expected to records be in stock
3. Tracer medicine Pharmacy Quarterly 4.19% <3% 9.3% <5% <1% <1% <1% stock-out rate records % (Institutions)
Number of tracer Pharmacy No 3 3 4 2 0 0 0 medicines stock out in records bulk store
Number of tracer Pharmacy No 43 43 43 43 43 43 43 medicines expected to records be stocked in the bulk store
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Estimated Audited/ Actual Performance Medium Term Targets Strategic Objective Performance Indicator Data source Type Performance 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
4. Number of Manageme Annual Not Reported Not Reported 01 mortuaries nt No rationalised
18.2 EQUIPMENT AND MAINTENANCE Table 41: District Equipment and Maintenance
Indicators Type Audited/ Actual performance Estimate MTEF Projection Provincial Target 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
1. Number of districts spending 0 0 0 0 1 1 1 more than 90% of maintenance budget
2. Proportion of infrastructure 1.4% 0.7% 2% 3% 3% 3% 3% budget allocated to maintenance
Numerator 17 936 000 17 341 718 15 716 192 22 051 000 25 000 000 28 000 000 31 000 000
Denominator 1 318 316000 1 173 949 000 1 359 379 924 1 675 076000 1 975032000 2 123 042000 2 359 270 000
3. Proportion of Programme 8 ( 77% 65% 52% 80% 100% 100% 100% infrastructure budget) spent on all maintenance (preventative and scheduled)
Numerator 13 813 937 17 341 718 15 716 192 22 051 000 25 000 000 28 000 000 31 000 000
Denominator 17 936 000 17 407 000 15 594 000 22 051 000 25 000 000 28 000 000 31 000 000
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18.3 EMERGENCY MEDICAL SERVICES (EMS) Table 42 (NDoH 31 (a)): Operational Ambulances per 10,000 Population Coverage (inclusive of LG)
District Type Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Abaqulusi 0.24 0.29 0.29 0.43 0.48 0.50
Edumbe 0.22 0.33 0.45 0.67 0.78 0.81
Nongoma 0.14 0.19 0.39 0.43 0.48 0.50
Ulundi 0.22 0.26 0.29 0.39 0.43 0.45
Pongola 0.23 0.31 0.31 0.54 0.62 0.65
District 0.21 0.27 0.32
Table 43 (NDoH 31 (b)): Ambulance Response Time Rural under 40 minutes (Inclusive of LG)
Audited/ Actual performance Estimate MTEF Projection Provincial Target 2015/16 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Abaqulusi 4559 5400 6300 33%
Edumbe 1793 1600 3000
Nongoma 2838 2500 3400
Ulundi 4111 3960 4300
Pongola 2277 2100 3600
District 15578 15560 19600 33%
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Table 44 (NDoH 31(c)): Ambulance Response Times Urban under 15 minutes (Inclusive of LG)
Ambulance Response Time: Urban Audited/ Actual performance Estimate MTEF Projection Provincial Target
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2015/16
Abaqulusi
Edumbe
Nongoma
Ulundi
Pongola
District Average
Table not applicable to Zululand
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19. HUMAN RESOURCES
Table 45 (NDoH 32): Performance for Human Resources
TOTAL POSTS FILLED Audited/ Actual performance Estimate MTEF Projection
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Health district Personnel category1
ABAQULUSI PHC facilities
Medical officers 0 0 0
Professional nurses 93 91 128
Pharmacists 0 0 0
District hospitals
Medical officers 24 9 12
Professional nurses 135 134 144
Pharmacists 7 8 5
Radiographers 2 5 5
EDUMBE PHC facilities
Medical officers 7 2 3
Professional nurses 62 56 60
Pharmacists 1 2 4
District hospitals
Medical officers
Professional nurses
Pharmacists
Radiographers
NONGOMA PHC facilities
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TOTAL POSTS FILLED Audited/ Actual performance Estimate MTEF Projection
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Medical officers 0 0 0
Professional nurses 55 54 47
Pharmacists 0 0 0
District hospitals
Medical officers 6 7 9
Professional nurses 171 168 168
Pharmacists 2 3 2
Radiographers 2 3 3
ULUNDI PHC facilities
Medical officers 0 0 0
Professional nurses 97 78 162
Pharmacists 0 0 0
District hospitals
Medical officers 10 13 22
Professional nurses 179 220 243
Pharmacists 3 3 4
Radiographers 3 5 4
UPHONGOLO PHC facilities
Medical officers 0 0 0
Professional nurses 35 40 51
Pharmacists 0 0 0
District hospitals
Medical officers 5 6 9
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TOTAL POSTS FILLED Audited/ Actual performance Estimate MTEF Projection
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Professional nurses 81 78 83
Pharmacists 1 2 6
Radiographers 4 2 3
District PHC facilities
Medical officers 0 0 0
Professional nurses 342 319 448
Pharmacists 0 0 0
District hospitals
Medical officers 52 37 52
Professional nurses 566 600 638
Pharmacists 14 18 17
Radiographers 11 17 15
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Table 46 (NDoH 33): Plans for Health Science and Training
CONTINUOUS PROFESSIONAL CAPACITY BUILDING / INDICATORS Estimated Medium term targets TRAINING 14 performance
2014/15 2015/16 2016/17 2017/18
Adult education and training To improve literacy of employees thereby 98 35 consequently improve performance
NIMART To ensure health care providers will be equipped with 40 40 the clinical knowledge, skills, and attitudes in the initiating and managing ART clients in the district
Emergency triage assessment and Treatment To improve management of coma, shock and 24 24 convulsions in a child
Integrated Management of Childhood illnesses (IMCI) To monitor and evaluate the implementation of the 20 20 strategy to see if it will produce positive results in decreasing the child mortality rate.
Project management To ensure that all services and products are delivered 10 10 within time, budget and quality specifications to the satisfaction of the client.
Disaster Management To demonstrate procedures to deal with disaster 15 15 situations and relief measures and will leave candidate with a set of tools to deal with most situations
Effective construction contract management and To analyse the entire life cycle of construction 5 5 administration contracts so that the department understands the role and obligations in terms of contract planning
Mentoring for growth To ensure that employees understand the process of 25 25 deploying experienced individuals to provide guidance and advice that will help to develop the careers protégées allocated to them
14 This would include formal and informal (short courses, refreshers, etc.) courses.
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CONTINUOUS PROFESSIONAL CAPACITY BUILDING / INDICATORS Estimated Medium term targets TRAINING 14 performance
2014/15 2015/16 2016/17 2017/18
Writing minutes of meetings To expose employees on how to prepare effectively 5 25 for meetings, the structure and format of minutes and offers suggestions for writing minutes which are accurate, brief and clear.
Advanced paediatric life support To reinforce the important concept of a systematic 1 1 approach to paediatric assessment, basic life support, PALS treatment algorithms, effective resuscitation and team dynamics
Advanced cardiac life support To provide the skills in treating adult victims of 3 3 cardiac arrest or other cardiopulmonary emergencies
Basic life support To teach the professionals with skills of CPR and 4 4 choking for adults, children and infants
Customer care: Batho Pele way To assist employees in the department on how to 20 20 treat a customer both internal and external
Ultra sound To improve service to the patients by means of 4 2 ultrasonography
Financial management To enable the employees to demonstrate an 1 15 understanding of the Public Finance Management Act and related Treasury Regulations
First Aid training To provide the comprehensive set of practical skills 6 6 needed by first aiders in most workplaces to become a confident first aider at work.
HIV & AIDS Counselling To ensure that the employees understand about 10 10 HIV/AIDS counselling since it is essentially about educating and counselling communities in the control, management and prevention of HIV/AIDS.
Post basic pharmacy course To develop the skills of the pharmacy assistant who 4 4 were appointed with a matric certificate to be recognised as qualified pharmacy assistants.
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CONTINUOUS PROFESSIONAL CAPACITY BUILDING / INDICATORS Estimated Medium term targets TRAINING 14 performance
2014/15 2015/16 2016/17 2017/18
Supervisory skills To ensure that supervisors must learn to make good 10 10 decisions, communicate well, assign work delegate and plan, train people, motivate people and deal with various specialists in the departments.
Occupational Health and Safety Reps To provide employees with a working knowledge of 21 21 Occupational Health and Safety that can be applied to any departmental environments
TB Management To ensure that clinical staff have understanding 6 6 regarding TB Management
Supply chain management To assist all public financial managers and Senior 9 9 public officials to effectively comply with the legislation regarding SCM
Advanced Medical Life Support for Doctors To teach the professionals with skills of CPR and 3 3 choking for adults, children and infants
Sign Language Clinical staff are unable to communicate with deaf 5 5 patients
Security Course To maintain order at a set location and provide a 10 10 visible prominent and reassuring presence to a company’s employees and members of the department
Fire Fighting To equip employees with the knowledge and 6 6 necessary skills to manage and extinguish a fire in the office environment
Managing Poor Work Performance To develop the skills of employees through 20 performance
Conduct management To develop the skills of the employees on conduct 3 management course
Telephone etiquette To develop the skills of the employees on Telephone 25 adequate
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CONTINUOUS PROFESSIONAL CAPACITY BUILDING / INDICATORS Estimated Medium term targets TRAINING 14 performance
2014/15 2015/16 2016/17 2017/18
Communication skills To develop the skills of the employees in 15 communication Skills
Delivery Management To upgrade the skills of the employees in service 5 delivery
Labour Relations Act To improve the knowledge of supervisors labour 10 relations line function
Trauma Counselling To develop the skills of the employees in Trauma 10 counselling
Public Service Induction To ensure that new recruits understand the goals, 40 structures and key policies of government
Update and Diabetes Update and Diabetes 5
Control Stock Control Stock 10
Basic Nutrition For efficiency and effectiveness of Basic nutrition in 4 the department
Advance Management And Development Programme To emphasis on development of Middle 15 Management to build their leadership and management capacity
Persal Management To develop the skills of the employees on Persal 25 Management
Advanced Cardiac Vascular Life Support To improve quality care of ACVLS for Doctors 8
MDR Management For efficiency and effectiveness of clinical service 5 delivery
Electrical management For efficiency and effectiveness of maintenance 5
Plumbing course For efficiency and effectiveness of maintenance 5
Chairing meetings effectively To develop employees through chairing meeting 25 effectively
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CONTINUOUS PROFESSIONAL CAPACITY BUILDING / INDICATORS Estimated Medium term targets TRAINING 14 performance
2014/15 2015/16 2016/17 2017/18
Intensive counselling To improve skills and knowledge of counselling in the 10 department
Risk management To be equipped with the necessary knowledge as to 12 manage risks within the component
Finance for none financial To provide leadership and management 5 competencies
Investigating course To improve the knowledge of supervisors labour 10 relations line function
Presiding Course To improve the knowledge of supervisors labour 10 relations line function
Train the trainer To develop the skills of the employees in the 30 department
SMS &MMS Course To develop the skills of the SMS & MMS 20
Assets management To provide leadership and management 10 competencies
Logistics & warehouse To provide leadership and management 15 competencies
Acquisition management To provide leadership and management 10 competencies
Defensive driving To develop skills of officials as required 10
Bereaved counselling For efficiency and effectiveness of forensic service 5 personnel
4x4 Advanced driving To develop skills of officials as required 10
Diploma in Primary Health Care For efficiency and effectiveness of clinical service 5 delivery
DCST SA Child health priorities For efficiency and effectiveness of clinical service 5 delivery
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CONTINUOUS PROFESSIONAL CAPACITY BUILDING / INDICATORS Estimated Medium term targets TRAINING 14 performance
2014/15 2015/16 2016/17 2017/18
Time management To provide core training programmes through time 15 management
Suspense account To improve skills and knowledge of Basic Accounting 10 System
Breast feeding For efficiency and effectiveness of clinical service 15 delivery
Infection control To improve the assessment and treatment of STIs 15
Data management To enhance and improve behavioural patterns of 10 managers
Emerging management Development Programme To provide leadership and management 15 competencies
Family planning For efficiency and effectiveness of clinical service 2 delivery
FIDSSA Congress For efficiency and effectiveness of clinical service 1 delivery
Prevention of Mother to child transmission For efficiency and effectiveness of clinical service 3 delivery
Monitoring and Evaluation To provide leadership and management 25 competencies
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20. DISTRICT FINANCE PLAN
Table 47 (NDoH 34): District Health MTEF Projections
Sub-programme Audited outcome Main Adjusted Revised Medium term expenditure estimates appropriation appropriation estimate
R’ thousand 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
District 10 577 751 13 039 000 11 179 658 12 962 000 12 962 000 12 490 000 13 240 000 14 034 000 14 876 000 Management
Clinics 247 823 865 274 185 000 304 990 447 329 373 000 329 793 000 324 209 000 343 662 000 364 282 000 386 138 000
Community Health 40 177 813 39 916 000 43 163 646 38 864 000 42 294 000 51 482 000 54 571 000 57 845 000 61 316 000 Centers
Community Nil Nil 2 568 344 Services
Other Community 50 221 885 52 213 000 69 170 371 74 395 000 74 395 000 82 582 000 87 537 000 92 790 000 98 357 000
Coroner Services 8 782 646 8 764 000 9 129 510 9 457 000 9 457 000 8 862 000 9 394 000 9 957 000 10 555 000
HIV and AIDS 117 182 452 135 736 000 197 229 251 220 854 000 212 854 000 236 463 000 250 652 000 265 691 000 281 632 000
Nutrition 2 834 568 3 690 000 3 909 047 3 780 000 3 780 000 4 172 000 4 423 000 4 688 000 4 969 000
District Hospitals 557 473 543 642 639 000 718 039 650 742 113 000 752 413 000 801 383 000 849 467 000 900 435 000 954 461 000
Environmental 8 966 807 7 088 000 6 158 968 1 610 000 1 610 000 2 951 000 Health Services
TOTAL 944 040 327 1 173 949 000 1 359 379 924 1 433 408 000 1 439 558 000 1 524 594 000 1 612 946 000 1 709 722 000 1 812 304 000
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Table 48 (NDoH 35): District Health MTEF Projections per Economic Classification
R’ Thousands Main Medium-term estimate Audited Outcomes appropriation Adjusted appropriation Revised estimate
2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Current payments 1 523 719 535 1 623 017 000 1 631 167 000 1 693 324 000 1 794 924 1 902 620 2 016 777 000 000 000
Compensation of 792 865 000 1 000 359 000 1 123 255 751 1 194 455 000 1 193 455 000 1 219 412 000 1 292 577 1 370 132 000 1 452 340 employees 000 000
Goods and services 252 871 000 366 911 000 400 463 784 428 562 000 437 712 000 473 912 000 502 347 000 532 488 000 564 437 000
Transfers and subsidies to 1 216 000 87 000 45 266 179 37 878 000 37 878 000 68 720 000 72 845 000 77 215 000 81 849 000
Payments for capital assets 29 047 000 5 405 000 12 409 920 6 031 000 6 031 000 4 015 000 4 256 000 4 512 000 4 782 000
Total economic 1 075 999 1 372 792 000 1 581 395 634 1 666 926 000 1 675 076 000 1 766 059 000 1 872 025 1 984 347 000 2 103 408 classification 000 000 000
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PART C: LINKS TO OTHER PLANS
21. CONDITIONAL GRANTS (WHERE APPLICABLE)
Table 49 (NDoH 36): Outputs of a result of Conditional Grants
Name of conditional Purpose of the grant Performance indicators Indicator targets grant (extracted from the Business Case prepared for each Conditional Grant for 2015/16 COMPREHENSIVE HIV AIDS CONDITIONAL GRANT (Applicable to all Districts)
Antiretroviral 1.To enable the health sector to develop an effective Number of Public health facilities Offering ART 78 treatment (ART) response to HIV and AIDS including universal access to HIV Number of Adult ART patients remaining in care 6 259 interventions Counselling and Testing Number of ART patients remaining in care - Child (current active) 91 996 Number of registered ART patient’s total 10 2. Provision of comprehensive care, treatment and Number of deregistered ART patients due to loss to follow-up 10 support for people affected by HIV and AIDS through Number of deregistered ART patients due to death strengthening of the National Health System.
3. To subsidize in part funding for the antiretroviral treatment plan
High transmission Number of HTA intervention sites 8 area (HTA) Number of male condoms distributed 150 000 interventions Number of female condoms distributed 15000
02
Post exposure Number of sexual assault cases – new prophylaxis (PEP) Number. of sexual assault cases offered ARV prophylaxis after sexual assault Number of sexual assault cases offered comfort kits
Prevention of Number of ANC clients tested positive for HIV mother to child Number of ANC clients initiated on life-long ART transmission (PMTCT) Number of babies given Nevirapine within 72 hours after birth Number of babies PCR tested at 6 weeks
Voluntary Proportion clients HIV pre-test counselled (excl. antenatal) counselling and Number of clients tested for HIV (excluding antenatal testing (VCT) Any HIV rapid test kits stock out Number of non-medical sites offering VCT
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Name of conditional Purpose of the grant Performance indicators Indicator targets grant (extracted from the Business Case prepared for each Conditional Grant for 2015/16 COMPREHENSIVE HIV AIDS CONDITIONAL GRANT (Applicable to all Districts)
Tuberculosis (TB) and The number of HIV positive clients who have been screened for TB immediately after HIV combined being diagnosed with HIV for the first time management The number of HIV positive clients started on INH prevention therapy for the first time during the reporting period. Number of confected TB/HIV positive patients registered at an ART service point that starts ART.
Male medical No. of fixed facilities offering MMC 26 No. of medical male circumcision performed 46 528 circumcision (MMC No. of circumcised males reporting adverse events 0
Home-based care Number of active home-based carers 1011 Number of active home-based carers receiving stipends 1011 Number of beneficiaries served by home-based carers 1125 Number of home households visited by home-based carers 672 480 Number of care kits purchased 1898
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22. PUBLIC-PRIVATE PARTNERSHIPS (PPPS) AND PUBLIC PRIVATE MIX (PPM)
Table 50 (NDoH 38): Outputs as a result of PPP and PPM
Name of PPP or PPM Purpose Outputs Current Annual Budget (R’Thousand) Date of Termination Measures to ensure smooth transfer of responsibilities
1.
2.
PART E: INDICATOR DEFINITIONS
Indicator Short Definition Purpose of Primary APP Method of Calculation Calculatio Type of Reporting Data Desired Indicator Indicator Source Source n Type Indicator Cycle Limitations Performance Responsibilit y
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